Patient Information

---

 TMJ Sleep & Orofacial Pain Professionals is a fee-for-service specialty practice.
We are not in network with any dental or medical insurance plans, and we do not bill, submit, or process insurance claims on behalf of patients.

Payment is required in full at the time of service for all evaluations, follow-up visits, procedures, appliances, and treatment.

If you wish to seek reimbursement on your own, our office can provide a detailed superbill that you may submit directly to your insurance carrier.
Please note: reimbursement is not guaranteed.

We do not accept single case agreements, gap exceptions, or any insurance-based contracts for services.

Because our office does not file or manage dental or medical insurance claims:

• We cannot assist with coverage disputes
   
• We do not contact insurance companies
   
• We do not handle appeals, denials, coordination of benefits, or eligibility issues
   

All questions regarding coverage or reimbursement must be directed to your insurance carrier.

HIPAA NOTICE OF PRIVACY PRACTICES 

TMJ Sleep & Orofacial Pain Professionals 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. 

We are required by federal and state law to maintain the privacy of your health information. This Notice explains your rights and our legal responsibilities regarding your health information. 

USES AND DISCLOSURES OF HEALTH INFORMATION We may use and disclose your health information for treatment, payment, and healthcare operations. 

TREATMENT We may share your information with healthcare providers involved in your care, including specialists, sleep physicians, neurologists, and dentists. 

PAYMENT We may use and disclose your information to obtain payment from insurance companies, case managers, or third-party payers. 

HEALTHCARE OPERATIONS We may use your information for quality improvement, staff training, accreditation, licensing, and other administrative functions. 

OTHER DISCLOSURES We may use or disclose your information for research and education when permitted by law. 

YOUR AUTHORIZATION We will not use or disclose your information for purposes outside this Notice unless you authorize it. You may revoke authorization in writing at any time. 

FAMILY AND FRIENDS We may communicate with individuals involved in your care only with your authorization. 

REQUIRED BY LAW We may disclose information when required by law. 

NATIONAL SECURITY We may disclose information to military or federal authorities when legally permitted. 

APPOINTMENT REMINDERS With your authorization, we may send appointment reminders via phone, email, text, or mail. 

PATIENT RIGHTSACCESS You may review or request copies of your health information. Requests must be in writing. 

ACCOUNTING OF DISCLOSURES You may request a list of disclosures made in the past six years, excluding those for treatment, payment, and operations. 

RESTRICTION You may request additional restrictions on disclosures. We are not required to agree, but if we do, we will follow them. 

ALTERNATIVE COMMUNICATION You may request alternative communication methods or locations in writing. 

AMENDMENT You may request an amendment to your health information. We may deny inappropriate requests. 

ELECTRONIC NOTICE If you received this Notice electronically, you may request a paper copy. 

QUESTIONS AND COMPLAINTS 

You may file a complaint without fear of retaliation. 

CONTACT INFORMATION TMJ Sleep & Orofacial Pain Professionals 5340 E Broadway Blvd, Suite 150 Tucson, AZ 85711 Phone: 520-748-8186 

You may also contact: Office for Civil Rights U.S. Department of Health & Human Services 200 Independence Avenue, S.W. Washington, DC 20201 Phone: 1-877-696-6775

Have questions or comments? We'd love to hear from you! Contact us today and we'll get back to you as soon as possible.