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New Patient Information Brochures

Patient Resources

  • PATIENT RIGHTS and NON-DISCRIMINATION NOTICE

    PATIENT RIGHTS and
    NON-DISCRIMINATION NOTICE

    We respect your rights as a patient and recognize that you are an individual with unique healthcare needs. As your partners in oral health, we have identified the specific rights you can expect while in our care.

    Learn More
  • Patient Privacy

    PATIENT
    PRIVACY


    We protect the privacy and security of our patients’ health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

    Learn More
  • Language Assistance Services

    LANGUAGE ASSISTANCE
    SERVICES


    Our clinics will take reasonable steps to provide translation services to patients with limited English proficiency upon request. This service will assist with discussion of your dental care. Family or friends cannot act as translators.

    Learn More
  • Release of Records

    RELEASE
    OF RECORDS


    Patients can receive copies of their dental record and/or radiographs (x-rays) upon request. A photo ID is required to process all requests for record release or transfer.

    Request a Copy

No Surprise Act:

Your Rights and Protections Against Surprise Medical Bills

Good Faith Estimate

Under the Federal No Surprise Act, health care providers need to give patients who don’t have insurance or who are not using insurance a good faith estimate of the bill for dental services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any items or services scheduled at least three business days in advance, unless it is an emergency.
  • You should receive a Good Faith Estimate in writing at least 1 business day before your dental service or item, unless you requested and consented for service immediately. You can also ask your provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill in the federal patient-provider Select Dispute Resolution Process.
  • Make sure to save a copy or picture of your Good Faith Estimate.

Requesting a Good Faith Estimate

UTHealth Houston School of Dentistry and UT Dentists are happy to provide estimates for services for patients who don’t have insurance or who are not using insurance. In order to enhance accuracy when you request an estimate, please provide the procedure code (CDT/CPT) for the services that are of interest.

This information can be provided to you assigned clinic. It is important to ensure you are being provided an estimate for the appropriate treatment or procedure in writing (email or mail) within 2-3 business days.

For more information about your right to a Good Faith Estimate, visit Centers for Medicare & Medicaid Services

Additional Questions? Contact your assigned clinic.