At Harbor Light Oral & Maxillofacial Surgeons, Inc. we make every effort to provide you with the finest care and the most convenient financial options. To accomplish this we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures. If you have any problems or questions, please ask our staff. They are well informed and up-to-date. 

Please call if you have any questions or concerns regarding your initial visit.


Please bring your insurance information with you to the consultation so that we can expedite reimbursement.

  • A designated privacy and security officer is appointed from within the Practice to oversee the policies and procedures to ensure that patients’ rights to privacy are fulfilled.
  • All patients arriving for care receive a Notice of Patients’ Privacy Rights and the Receipt of Notice of Privacy Practices Written Acknowledgment Form. All patients are asked to acknowledge receipt form.
  • The Practice obtains written acknowledgment from the patient or legal guardian prior to engaging in treatment, payment or healthcare operations.
  • An individual has a right to receive an accounting of disclosures of PHI made by a covered entity in the three years prior to the date on which the accounting is requested, except for disclosures defined in HIPAA. The Practice obtains written authorization for use or disclosure of PHI in connection with research and marketing.
  • The Practice discloses only the minimum PHI to requesting entities and insurance companies in order to accomplish the intended purpose.
  • As a covered entity, the Practice fully complies with the HIPAA Privacy Rule, effective April 14, 2003.
  • The Practice provides the patient, in the Notice of Privacy Practices, a clear, written explanation of how a covered entity may use PHI.
  • Patients can request a correction or amendment to their PHI. Any allowed amendments must be in a written amendment; no changes are made directly to the medical record. The Practice must inform patients that a written request for a correction or amendment is required, and that the patient is required to provide a reason to support the requested change. The amendment is accepted or denied in a provider’s written response, on a Disposition of Amendment Request.
  • Patients can have access to their medical records. If the Practice is unable to provide copies based upon the HIPAA guidelines, written notice, in the form of the Patient Denial Letter, is provided to the patient.
  • Anyone who feels the confidentiality of a patient’s PHI has been violated may submit a Patient Complaint to the Privacy and Security Officer. Complaints are kept confidential, and no repercussion may occur due to the report. Complaints are logged in the Privacy and Security Officer’s Incident Event Log.
  • Sanctions are imposed upon employees who violate the privacy of a patient’s PHI; sanctions may vary from a warning to termination.
  • All employees of the Practice receive initial and ongoing training on how to prevent misuse of PHI and how to obtain authorization for its use.
  • The Practice secures a Business Associate Agreement between the Practice and other covered entities that share PHI. The Practice and other entities performing services on behalf of the Practice release no PHI to employers or financial institutions without explicit authorization from the patient or legal guardian.
  • Electronic, physical and logistical safeguards are implemented to secure the confidentiality of all patients’ PHI.
  • The Practice maintains secure, electronic access to patient data when its providers require it.
  • The patient may submit a Request for Limitations and Restrictions of Protected Health Information.
Financial/Cancellation Policy

We believe that all patients deserve the very best dental care Harbor Light can provide. We also believe that everyone benefits when specific financial arrangements are agreed upon. The following is a statement of Harbor Light’s Financial Policy which we require that you read and sign prior to any treatment. 

Full Payment is due at time of service. We accept cash, checks, Visa, Mastercard, Discover, American Express and debit cards. We also offer Care Credit, which is an extended payment plan with prior approval.

Regarding Insurance

We request that any co-payments, coinsurance, deductibles and any services not covered by insurance be paid at the time service is provided. The balance is your responsibility whether your insurance company pays or not.  We cannot bill your insurance unless you bring in all insurance information at your initial visit. Your insurance policy is a contract between you and your insurance company. We are not a party to that contract. Please be aware that some and possibly all of the services provided may be non-covered services and not considered reasonable, usual and customary under the terms of your dental and/or medical policy.

Minor Patients

The parent (or guardian) accompanying a minor is responsible for full payment at time of service. 

Payment Plans

Harbor Light has partnered with CareCredit, a patient financing company, to offer our patients 0% interest financing for 3, 6 or 12 months with approval.  No other payment plans are available.


Refunds for overpayment will be sent after all treatment is completed and insurance has been collected. 


Any account that has not received payment in 90 days will be handed over to a collection agency that will pursue the responsible party for reimbursement.  A $75 collection fee will be added to your account. 

Thank you for understanding Harbor Light’s  financial policy.  Please let us know if you have any questions or concerns by calling (419) 517-2100. We look forward to providing the highest quality dental care in a relaxing and caring atmosphere. 

Cancellation & No Show Policy

The appointment time you have selected is very valuable to both of us. Harbor Light’s Cancellation Policy requires a 48-hour (two business days) advanced notice for any rescheduling or cancellation of your appointment. Only one advance notice cancellation will be permitted. We understand that unforeseen circumstances may arise; cases will be reviewed on an individual basis. Unfortunately, patients who fail to follow this policy will not be allowed to reschedule an appointment.

Financing Options

Harbor Light has partnered with CareCredit, a patient financing company, to offer our patients 0% interest financing for 3, 6 or 12 months with approval.  No other payment plans are available.


For more information on CareCredit or Lending Club and its program, click on the link or contact our office at (419) 517-2100.