Patient Resources

image

 

 

Required Documents for First Visit

To ensure your first visit to the Dental Care Center is as efficient as possible, please complete and bring with you forms from the Program Selection Appointment Packet

Please be sure to also bring with you: 

  • A valid form of government ID
  • Your insurance card(s)
  • A list of all of your medications
  • If you are the legal guardian or guarantor, please bring the legal documents with you at the time of the appointment.  

Patient Privacy Policy  

The patient record is an important legal and professional document. Rules governing their ownership, maintenance, content, access and confidentiality are subject to strict legal review and control by several governmental agencies. Our goal is to protect and maintain the integrity and confidentiality of our patients' health information. This information may not be released to anyone under any circumstances, except by court order or waiver signed by the patient (or parent or legal guardian as appropriate). 

Stony Brook Medicine’s Notice of Privacy
 

Request Your Records

Patients have the right to access the information contained within their records. Patient requests for copies of records or radiographs should be directed to the Director of Patient Services or designee. A written request is required since penalties for breach of information contained in the record may be severe.

Know Your Rights 

Patients' Bill of Rights

The faculty, residents, students and staff of the Dental Care Center recognize that while you are a patient here, you have a right, consistent with law to:

  1. Understand and use these rights. If for any reason you do not understand, or you need help, the Dental Care Center will provide assistance, including an interpreter.
  2. Receive treatment without discrimination as to race, color, religion, sex, national origin, disability, sexual orientation or source of payment.
  3. Receive considerate and respectful care in a clean and safe environment, free of unnecessary restraints.
  4. Privacy in keeping with the Dental Care Center’s policies while receiving treatment and confidentiality of all information and records regarding your care.
  5. Know the names, positions and functions of any member of the faculty, student body and staff of the Dental Care Center involved in your care, and to refuse their treatment, examination or observation.
  6. Have access to complete and current information about your diagnosis, treatment and prognosis.
  7. Receive all the information that you need to give informed consent for any proposed procedure or treatment. This information will include an explanation of recommended treatment, treatment alternatives, expected outcomes of various treatments, and the possible risks, benefits and alternatives of the procedures or treatments.
  8. Refuse treatment and be told what effect this may have on your health.
  9. Participate in decisions about your treatment.
  10. Continuity and completion of treatment.
  11. Treatment that meets the standard of care in the profession.
  12. Receive advanced knowledge of the cost of treatment and an itemized bill with an explanation of all charges.
  13. Review your dental record without charge, and/or obtain a copy of your dental records and/or obtain a copy of your x-rays, for which the Dental Care Center can charge a reasonable fee. You cannot be denied a copy solely because you cannot afford to pay.
  14. Receive emergency care if you need it, provided that the care which is required can be delivered consistent with the educational program of the school and the personnel and facilities of the clinic.
  15. Refuse to take part in research. In deciding whether or not to participate, you have the right to a full explanation.
  16. Complain without fear of reprisal about the care and services you are receiving and to have the Dental Care Center respond to you, and if you request it, a written response. If you are not satisfied with the response, you can register a concern with the New York State (NYS) Department of Health. The Dental Care Center must provide you with the telephone number of the NYS Department of Health: (518) 474-3817. 

Guide to Patient Services 

The Guide to Patient Services is provided to each person upon arrival for their Program Selection Appointment and serves as a reference for a patient’s rights and as a guideline for the policies of the Dental Care Center. 

Financial Policy and Information  

Patients are expected to pay in full for treatment rendered at the time of service. We are participants in several insurance plans. For non-participating plans, upon request, we will provide you with an ADA claim form and all diagnostic tools, which you can submit to your insurance company for reimbursement.

  • For the plans that the Dental Care Center (DCC) participates with, patients are responsible for all deductibles and copayments associated with their insurance.
  • For Urgent Care Center appointments, only cash or credit cards are accepted as payment.
  • For insurance or finance inquiries, please call (631) 632-8989 and follow the prompts.

To view more detailed policy information online, please view page five of our Guide to Patient Services.

Insurance Information

Provided below is a list of the dental plans that we participate with. It is important for you to check whether we participate in your specific plan. Please contact your plan to confirm our participation. 

Medicaid / Medicaid HMO Plans

Dental Carrier Dental Plan
New York State Medicaid
Dentaquest Affinity Health Plan
Dentaquest Affinity Health – Child & Family Plus (CHP)
Dentaquest Fidelis (Child Health Plus) 
Dentaquest Fidelis Adult Medicaid
Dentaquest Healthfirst Medicaid
Dentaquest Healthfirst Family Health Plus
Dentaquest Healthfirst (Child Health Plus)
Dentaquest Emblem Health Plan (Child Health Plus)
United Health Care Community Plan Medicaid
United Health Care Community Plan Child Health Plus
 

Private Dental Insurance Accepted

CSEA Employee Benefit Fund
Cigna PPO
Delta Dental PPO*
Emblem Health Preferred PPO**

* We do not participate with Delta Care USA. Delta has many dental plans; please check your card for the correct plan.
** This includes GHI and HIP (No HMO)