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Office & Financial Policies
Keystone Dental Studio is committed to providing high-quality dental care in a professional and respectful environment. By scheduling, presenting for, or receiving treatment at our office, patients and/or responsible parties acknowledge they have been given access to these policies and agree to be bound by them — in written, electronic, or verbal form, whether or not a signature is obtained.
Acceptance of these policies is a condition of treatment.
Keystone Dental Studio · 2128 Perkiomen Ave, Reading, PA 19606 · Effective July 2026
Payment is due in full at the time services are rendered, unless prior written financial arrangements have been approved. The patient and/or responsible party:
Keystone Dental Studio is a fee-for-service, cash-pay practice. We do not participate in-network with any dental insurance plans and do not bill insurance carriers directly, for any patient — whether uninsured or covered by an out-of-network plan.
As a courtesy, upon request we can provide a detailed statement of services rendered (sometimes called a "superbill") that a patient may choose to submit on their own to their insurance carrier for possible out-of-network reimbursement. Whether a plan reimburses, and how much, is determined solely by the patient's insurance carrier; Keystone Dental Studio makes no representation about coverage or reimbursement and is not a party to that contract.
We accept cash, check (with valid identification), and major credit cards (Visa, Mastercard, Discover). We also offer in-house payment plans and third-party financing through CareCredit and Cherry. Returned checks will incur a $40 fee.
Payment plans or financing arrangements must be approved in advance and documented in writing. Failure to comply with agreed payment terms may result in the immediate balance becoming due and/or suspension or termination of treatment.
Patients agree to pay all associated collection costs, including collection agency fees, attorney fees, and court costs.
Treatment estimates are valid for 90 days only and may change due to clinical findings or changes in the treatment plan.
The parent or legal guardian accompanying a minor is fully financially responsible for all services rendered. The practice will not mediate financial or custody disputes between parents or guardians.
Appointment times are reserved specifically for each patient. Missed or late appointments impact our ability to provide care to all patients.
Patients arriving more than 10 minutes late may be rescheduled at the discretion of the office.
A minimum of 48 hours' notice is required to cancel or reschedule an appointment. Failure to provide adequate notice will result in a $50 missed appointment fee.
A missed appointment includes failure to attend a scheduled appointment, or cancellation with less than 48 hours' notice. Policy: $50 fee per occurrence; three (3) occurrences may result in dismissal from the practice. New patients who fail to attend or properly cancel their initial appointment may not be rescheduled.
Patients are responsible for maintaining accurate contact information. Failure to receive reminders (phone, voicemail, text, or email) does not waive appointment responsibility or associated fees.
Keystone Dental Studio reserves the right to cancel or reschedule appointments due to circumstances including, but not limited to, provider illness, staff shortages, equipment failure, facility issues, or emergencies and unforeseen events. The office will make reasonable efforts to notify patients using available contact methods.
Patients acknowledge and agree that appointment times are not guaranteed and the practice is not liable for lost wages, travel expenses, inconvenience, or any related damages, and will not provide compensation, reimbursement, or reciprocal cancellation fees under any circumstances. The office will make reasonable efforts to offer the next available appointment and accommodate urgent needs when appropriate.
Keystone Dental Studio maintains a zero-tolerance policy for:
Violation of this policy may result in immediate dismissal from the practice.
The practice reserves the right to terminate the doctor-patient relationship at its discretion, in accordance with Pennsylvania law and professional standards. Grounds for dismissal include, but are not limited to: repeated missed appointments or non-compliance; failure to follow recommended treatment; non-payment or delinquent accounts; violation of office policies; or inappropriate or unsafe behavior.
Dismissal may be communicated verbally and may be effective immediately. Written confirmation will follow and will be sent to the patient's last known address.
Following dismissal, emergency dental care will be available for 30 days, limited to urgent conditions only. Patients are responsible for securing care with another provider. Records will be released upon written authorization.
Patients authorize the dentist and clinical staff to perform necessary diagnostic and treatment procedures, including radiographs, as deemed appropriate.
Keystone Dental Studio does not bill insurance carriers directly. Upon a patient's request, the office may prepare and release a statement of services to that patient for the patient's own use in seeking reimbursement from their insurance carrier. Patients are responsible for submitting this statement and pursuing any reimbursement themselves.
Patients consent to communication via phone, voicemail, text message, and email for purposes including scheduling, billing, and treatment coordination.
The practice is not responsible for a patient's insurance carrier's coverage determinations, delays, or denials; missed communications due to outdated contact information; or consequences resulting from patient non-compliance.
Any dispute, claim, or controversy arising out of or relating to treatment, billing, services, or these policies shall be resolved exclusively through binding arbitration. Arbitration shall be conducted under the rules of the American Arbitration Association, will take place in Pennsylvania, and will be decided by a single neutral arbitrator whose decision shall be final and binding.
Patients waive the right to a jury trial or court proceeding.
Claims must be brought individually (no class actions) and must be filed within applicable Pennsylvania legal time limits.
This Privacy Policy explains how Keystone Dental Studio ("we," "our," or "the practice") handles information in connection with this website (keystonedentalstudio.com). It is separate from our HIPAA Notice of Privacy Practices, which governs Protected Health Information (PHI) we maintain as a covered health care provider.
We do not collect personal information through this website. When any website is visited, the hosting provider may automatically process limited technical data (such as IP address and browser type) briefly for traffic routing, security, and abuse prevention; we do not use this to identify you and we do not build advertising profiles.
This website is hosted on Cloudflare Pages, which delivers the site and provides standard security and content-delivery functions. Fonts are loaded from Google Fonts and the location map is embedded from Google Maps; these providers may receive standard request data (such as IP address) needed to serve those resources.
If you email or call us, we use your information solely to respond, schedule, and follow up on your care. We do not sell, rent, or share your information with third parties for marketing. Please do not send sensitive medical history, diagnoses, or insurance member numbers by email — call us for anything sensitive.
This website is not directed at children under 13, and we do not knowingly collect information from children under 13 through the site.
The website is delivered over HTTPS with industry-standard encryption. No method of transmission over the internet is 100% secure; we use reasonable safeguards but cannot guarantee absolute security.
To ask what information we hold, correct it, request deletion of information we are not legally required to retain, or ask us to stop contacting you, call us at (610) 779-5123 or speak with our front desk. Material changes to this policy will be noted here.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Keystone Dental Studio is required by law to maintain the privacy of your Protected Health Information (PHI), provide you with this Notice of our legal duties and privacy practices, notify you following a breach of your unsecured PHI, and follow the terms of the Notice currently in effect. "Protected Health Information" means information that identifies you and relates to your past, present, or future physical or oral health, the provision of dental care to you, or payment for that care.
For Treatment. We use your PHI to provide and coordinate dental care — for example, sharing records with a referred specialist, lab, or oral surgeon involved in your care.
For Payment. Keystone Dental Studio does not bill dental insurance directly. We use and disclose PHI as needed to obtain payment for services — for example, processing payment through a third-party financing partner you have authorized (such as CareCredit or Cherry), or preparing a statement of services at your request for you to submit to your own insurance carrier.
For Health Care Operations. We use PHI for day-to-day operation of the practice — appointment reminders, quality improvement, training, and similar internal functions.
Appointment Reminders & Scheduling. We may contact you by phone, voicemail, text, or email to remind you of appointments or follow up on care, consistent with your contact preferences.
Business Associates. We may share PHI with third parties ("Business Associates") who perform services on our behalf — for example, our practice-management software vendor, claims processors, or IT support. Each is bound by a written agreement to protect your PHI under HIPAA.
As Required by Law. We may disclose PHI when required by federal, state, or local law — for example, in response to a court order or subpoena, or to public health authorities.
Other Permitted Disclosures. We may disclose PHI without authorization in additional limited circumstances permitted by HIPAA, including public health activities, reports of suspected abuse or neglect, health oversight activities, judicial and administrative proceedings, law enforcement purposes, organ donation, IRB-approved research, to avert a serious threat to health or safety, specialized government functions, workers' compensation, and to coroners, medical examiners, and funeral directors.
We will obtain your written authorization before using or disclosing your PHI for marketing communications (other than face-to-face and certain treatment-related communications), any sale of PHI, most uses of psychotherapy notes, and any other purpose not described in this Notice. You may revoke a previously given authorization in writing at any time, except where we have already acted in reliance on it.
Right to Inspect and Copy. You may inspect and obtain a copy of your PHI in our records by written request; we will respond within 30 days and may charge a reasonable, cost-based fee.
Right to Request an Amendment. If you believe information is inaccurate or incomplete, you may request an amendment. We may deny in limited circumstances and will explain in writing.
Right to an Accounting of Disclosures. You may request an accounting of certain disclosures made in the six years preceding your request, excluding treatment, payment, operations, and a few other categories.
Right to Request Restrictions. You may request restrictions on certain uses or disclosures. We are not required to agree, except for a disclosure to a health plan for payment or operations where you have paid in full out of pocket.
Right to Request Confidential Communications. You may ask us to communicate with you in a particular way or location; we will accommodate reasonable requests.
Right to a Paper Copy. You may request a paper copy of this Notice at any time.
Right to Be Notified of a Breach. You have the right to be notified following a breach of your unsecured PHI.
We reserve the right to change this Notice and to make the revised Notice effective for all PHI we already have as well as information we receive in the future. The current Notice will be posted in our office and on this page.
If you believe your privacy rights have been violated, you may file a complaint with our office or directly with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
To file with our office: speak with our Privacy Officer at the front desk, call (610) 779-5123 and ask for the Privacy Officer, or mail a written complaint to: Privacy Officer, Keystone Dental Studio, 2128 Perkiomen Ave, Reading, PA 19606.
To file with HHS: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201 · Phone 1-877-696-6775 · Online hhs.gov/ocr/complaints
For questions about this Notice or to exercise any of your rights — Privacy Officer, Keystone Dental Studio · (610) 779-5123 · 2128 Perkiomen Ave, Reading, PA 19606.
By receiving care at Keystone Dental Studio, patients acknowledge that these policies have been made available and agree to all terms.