SOUND DENTAL ENROLLMENT

  • Sound Dental Care Enrollment

    We look forward to serving you. Let's get started!

  • Tell us a little about yourself...

    Please help us customize your enrollment experience!

  • At Sound Dental Care, we understand that expanding access to care requires new approaches.  Unfortunately, paperwork is sometimes a barrier to delivering care so we are doing our best to make the process easier. We believe that every person involved in a loved one's care decision should be aware of the patient's dental options.  We hope this technology solution will make things a little easier and result in more people being served.

    Please select one of the following options.  Understanding who you are will help us build a shorter and more relevant enrollment process for you. 

    Please note that you have a right to a copy of your enrollment submission. We provide several options for receiving a copy of your enrollment at the end of the enrollment process.

  • Let's get started!

    Just one more quick question and we will dive into patient information...

  • Thank you for letting us know that you have a Power of Attorney!

    Once the enrollment is complete, we will reach out to your POA to make sure that everyone is on the same page about the dental care that our team provides.

  • Thank you for letting us know that you have a guardian!

    Once the enrollment is complete, we will reach out to your guardian to make sure that everyone is on the same page about the dental care that our team provides.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Image field 131

  • PATIENT INFORMATION

    If you need assistance, please give us a call at 206-745-3808. We would be happy to help you.

  • Please note that our dental services are only provided at contracted care facilities and we will require a contract with your Adult Family Home if one does not already exist. At this time we are not contracting with new facilities because we do not have the staffing capacity. 

    Part of the service agreement requires that the home is enrolling at least four residents.

    If you are unsure whether your Adult Family Home has an existing contract, please call the management at your community before completing your enrollment.

  • Unfortunately, Sound Dental Care does not currently offer services at private residences. Our practice is commited to providing a safe service, and we work closely with facilities and care communities that are licensed by Washington State.  If you are looking for a dentist in your local community, we recommend visiting the www.DentistLink.org website.

     

  •  - -

  • Image field 148

  • How can can we best serve the patient?

    Let's tailor the service to you! This question assists us in providing care options.
  • Image field 147

  • PRICING

  • Our team provides an all-inclusive preventative service in response to the patient's needs. The service includes dentist exams, patient evaluations, oral cancer screenings, and a variety of preventative services such as dental cleanings, denture cleanings, silver diamine treatments and fluoride varnish. At Sound Dental Care, we provide dentist exams or reviews either in-person or via teledentistry. Our approach to teledentistry involves taking oral photos during the dental appointment and forwarding images to our team of dentists for review, diagnosis, and minimally invasive care planning. We work with the patient and the family to determine how often care should be offered. Most patients choose to be seen by Sound Dental Care every 3 months or every 6 months. Please note that care reports are left with the care community.  

     

     We offer three ways to pay...

  • Share your Medicaid number with us. We proudly offer dental care to Medicaid patients. Medicaid will cover the cost of our services. 

    Pay with your insurance. Sound Dental Care accepts most private insurances and we will submit a claim on your behalf. In the event that your dental insurance does not provide full coverage, we will limit your out-of-pocket cost to the maximum private pay rate of $229 by writing off a portion of our negotiated insurance rates. Sound Dental Care will need a front/back copy of the dental insurance card to submit a claim. Sound Dental Care will bill your insurance for services rendered at our negotiated insurance rates, and your insurance provider will send you an Explanation of Benefits (EOB). If you are concerned about whether your insurance will provide coverage, just give us a call and we will work with your insurer to understand the available benefits. Many Medicare Advantage plans fully cover our services.

    Pay by check or credit card. We will limit your "out-of-pocket" cost for preventative services to a maximum of $229. The maximum out-of-pocket fee includes a facility-negotiated discount to our published rates. A Registered Dental Hygienist (RDH) will provide an oral evaluation, dental cleanings, fluoride treatments, and silver diamine fluoride treatment (SDF) (if authorized). We provide dentist exams or reviews either in-person or via teledentistry and these services are part of the all-inclusive fee.

    We will mail or email an invoice after the appointment.

     

     

  • Share your Medicaid number with us. We proudly offer dental care to Medicaid patients. Medicaid will cover the cost of our services. 

    Pay with your insurance. Sound Dental Care accepts most private insurances and we will submit a claim on your behalf. In the event that your dental insurance does not provide full coverage, we will limit your out-of-pocket cost to the maximum private pay rate of $119 for patients without teeth by writing off a portion of our negotiated insurance rates. Sound Dental Care will need a front/back copy of the dental insurance card to submit a claim. Sound Dental Care will bill your insurance for services rendered at our negotiated insurance rates, and your insurance provider will send you an Explanation of Benefits (EOB). If you are concerned about whether your insurance will provide coverage, just give us a call and we will work with your insurer to understand the available benefits. Many Medicare Advantage plans fully cover our services.

    Pay by check or credit card. We will limit your "out-of-pocket" cost for preventative services to a maximum of $119 for patients without teeth. The maximum out-of-pocket fee includes a facility-negotiated discount to our published rates. A Registered Dental Hygienist (RDH) will provide an oral evaluation, cancer screening, patient instructions, and a denture cleaning if the patient has dentures. We provide dentist exams or reviews either in-person or via teledentistry and these services are part of the all-inclusive fee.

    We will mail or email an invoice after the appointment.

     

     

  • Image field 134

  • PAYMENT CONSIDERATIONS (SELECTION REQUIRED)

    For patients that do not have insurance, Sound Dental Care extends a discount on our published fee schedules in a manner that is consistent with the negotiated fees for the facility. The terms for payment are provided under the "Acknowledgements and Authorizations" heading towards the end of the enrollment process.  You will have an opportunity review the payment terms before you complete your enrollment.
  • Image field 135

  • RESPONSIBLE PARTY INFORMATION

    Most of our patients have a family member or a POA assist them with bills and care decisions.
  • Format: (000) 000-0000.
  • Image field 136

  • PATIENT DENTAL INSURANCE COVERAGE

    Please skip this section if you do not have private dental insurance.
  • Format: (000) 000-0000.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Image field 137

  • Our preventative service is all-inclusive. The maximum out-of-pocket fee of $229 covers dentist exams, evaluations, dental cleanings, fluoride treatments, and silver diamine treatments, assuming that those services are authorized below. Most patients authorize ALL of the services that we provide.

  • Our service is all-inclusive. Medicaid will cover the financial cost of dentist exams, evaluations, dental cleanings, fluoride treatments, and silver diamine treatments; however, we are only able to provide services that are authorized. Most patients authorize ALL of the services that we provide.

  • All-inclusive Service for Patients without Teeth... We offer a collection of services at a maximum out-of-pocket fee of $119.

    Sound Dental Care does serve patients who do not have teeth, and patients with mostly broken teeth with or without root stumps. Our clinical team can deliver many of the same preventative procedures that you would find in a dental office, including dental exams, oral health evaluations, head and neck cancer screenings, and denture cleanings if the patient has a denture appliance. Most patients choose to be seen by our team every 6 months. Please note that care reports are left with the care community. Most patients authorize ALL of the services that we provide.

  • CARE SELECTIONS FOR PREVENTATIVE SERVICES

    Our team strongly recommends that you authorize all of the services offered here. Sound Dental Care is an all-inclusive service that covers everything offered below as part of the maximum out-of-pocket fee. We are offering these services based on your selections during the enrollment process.

  • CARE SELECTION FOR PATIENTS WITHOUT TEETH

    Sound Dental Care offers the following services for patients with no teeth, or mostly broken teeth with or without root stumps. We are offering the services based on your selections during the enrollment process.

  • CARE SELECTIONS FOR MEDICAID PATIENTS

    Our team strongly recommends that you authorize all of the services offered here. If the patient has a Medicaid dental benefit, Sound Dental Care is able to provide our all-inclusive service at no out-of-pocket cost to the patient. We are offering these services based on your selections during the enrollment process.

  • Dentist Exams and Dental Cleanings... Included as part of the all-inclusive service at a maximum out-of-pocket fee of $229.

    Our clinical team delivers the same preventative procedures that you would find in a dental office, including dentist exams, patient evaluations, dental cleanings, fluoride varnish applications & silver diamine applications. We provide an all-inclusive preventative service in response to the patient's needs. Fluoride and silver diamine will be provided if authorized below. We work with the patient and the family to determine how often care should be offered. Most patients choose to be seen by Sound Dental Care every 3 months or every 6 months. Please note that care reports are left with the care community.

  • Dentist Exams and Dental Cleanings... Included as part of the all-inclusive service at a maximum out-of-pocket fee of $119.

    Our clinical team delivers the same preventative procedures that you would find in a dental office, including dentist exams, patient evaluations, denture cleanings, fluoride varnish applications & silver diamine applications. We provide an all-inclusive preventative service in response to the patient's needs. Fluoride and silver diamine will be provided if authorized below. We work with the patient and the family to determine how often care should be offered. Most patients choose to be seen by Sound Dental Care every 3 months or every 6 months. Please note that care reports are left with the care community.

  • Dentist Exams and Cleanings... Included in your Medicaid benefit.

    Our clinical team delivers the same preventative procedures that you would find in a dental office, including dentist exams, patient evaluations, dental cleanings, fluoride varnish applications & silver diamine applications. We provide an all-inclusive preventative service in response to the patient's needs. Fluoride and silver diamine will be provided if authorized below. At Sound Dental Care, we provide our Medicaid patients with dentist exams either in-person or via teledentistry. Our approach to teledentistry involves taking oral photos during the preventative appointment and forwarding images to our Washington-licensed dentists for review, diagnosis, and minimally invasive care planning.We work with the patient and the family to determine how often care should be offered. Most patients choose to be seen by Sound Dental Care every 3 months or every 6 months. Please note that care reports are left with the care community.

  • Silver Diamine Treatment... Included as part of the all-inclusive service at a maximum out-of-pocket fee of $229.

    Silver Diamine Fluoride (SDF) is an antimicrobial liquid topical medication. It is used to slow or stop decay AND treat tooth sensitivity. The procedure involves drying the teeth, placing a small amount of SDF on visible cavities, allowing the solution to dry (about one minute), and applying fluoride over the application. SDF may slow or stop tooth decay and relieve sensitivity. There are possible side effects from SDF. The cavity and white pre-cavities will darken permanently as the decay process stops. Healthy tooth structure will not discolor. Discolored tooth structure can be covered or replaced with a filling at a later date. Tooth colored fillings and crowns may also discolor if SDF is applied to them. Normally this is temporary and can be polished off. If SDF comes in contact with skin and/or gums, temporary discoloration may occur. Skin discoloration will disappear in 1-3 weeks. Every reasonable effort will be made to ensure the success of SDF treatment; however, there is a risk that the procedure will not stop the decay, and no guarantee of success is granted or implied. This treatment to stop or slow decay may not prevent the cavity from growing. In that case the tooth will require further treatment, such as an additional SDF application, a filling or crown, a root canal or possibly an extraction. Declining SDF is an option; however, suspect lesions that are not treated may lead to continued deterioration of the tooth structure and cosmetic appearance. Symptoms may increase in severity. Alternatives to SDF treatment include placement of fillings, other restorations, or extractions. Photos that explain and visualize treatment outcomes can be found at the SoundDentalCare.com website. Please note that care reports are left with the care community.

  • Silver Diamine Treatment... Included as part of the all-inclusive service at a maximum out-of-pocket fee of $119 (if needed).

    Silver Diamine Fluoride (SDF) is an antimicrobial liquid topical medication. SDF treatments are offered as part of the appointment if the patient has broken teeth with or without root stumps. It is used to slow or stop decay AND treat tooth sensitivity. The procedure involves drying the teeth, placing a small amount of SDF on visible cavities, allowing the solution to dry (about one minute), and applying fluoride over the application. SDF may slow or stop tooth decay and relieve sensitivity. There are possible side effects from SDF. The cavity and white pre-cavities will darken permanently as the decay process stops. Healthy tooth structure will not discolor. Discolored tooth structure can be covered or replaced with a filling at a later date. Tooth colored fillings and crowns may also discolor if SDF is applied to them. Normally this is temporary and can be polished off. If SDF comes in contact with skin and/or gums, temporary discoloration may occur. Skin discoloration will disappear in 1-3 weeks. Every reasonable effort will be made to ensure the success of SDF treatment; however, there is a risk that the procedure will not stop the decay, and no guarantee of success is granted or implied. This treatment to stop or slow decay may not prevent the cavity from growing. In that case the tooth will require further treatment, such as an additional SDF application, a filling or crown, a root canal or possibly an extraction. Declining SDF is an option; however, suspect lesions that are not treated may lead to continued deterioration of the tooth structure and cosmetic appearance. Symptoms may increase in severity. Alternatives to SDF treatment include placement of fillings, other restorations, or extractions. Photos that explain and visualize treatment outcomes can be found at the SoundDentalCare.com website. Please note that care reports are left with the care community.

  • Silver Diamine Treatment... Included in your Medicaid benefit.

    Silver Diamine Fluoride (SDF) is an antimicrobial liquid topical medication. It is used to slow or stop decay AND treat tooth sensitivity. The procedure involves drying the teeth, placing a small amount of SDF on visible cavities, allowing the solution to dry (about one minute), and applying fluoride over the application. SDF may slow or stop tooth decay and relieve sensitivity. There are possible side effects from SDF. The cavity and white pre-cavities will darken permanently as the decay process stops. Healthy tooth structure will not discolor. Discolored tooth structure can be covered or replaced with a filling at a later date. Tooth colored fillings and crowns may also discolor if SDF is applied to them. Normally this is temporary and can be polished off. If SDF comes in contact with skin and/or gums, temporary discoloration may occur. Skin discoloration will disappear in 1-3 weeks. Every reasonable effort will be made to ensure the success of SDF treatment; however, there is a risk that the procedure will not stop the decay, and no guarantee of success is granted or implied. This treatment to stop or slow decay may not prevent the cavity from growing. In that case the tooth will require further treatment, such as an additional SDF application, a filling or crown, a root canal or possibly an extraction. Declining SDF is an option; however, suspect lesions that are not treated may lead to continued deterioration of the tooth structure and cosmetic appearance. Symptoms may increase in severity. Alternatives to SDF treatment include placement of fillings, other restorations, or extractions. Photos that explain and visualize treatment outcomes can be found at the SoundDentalCare.com website. Please note that care reports are left with the care community.

  • Fluoride Treatment... Included as part of the all-inclusive service at a maximum out-of-pocket fee of $229.

    Fluoride treatments are offered with each dental cleaning as part of the appointment. Fluoride treatments are recommended by the American Dental Association and help prevent tooth decay. Please note that care reports are left with the care community.

  • Fluoride Treatment... Included as part of the all-inclusive service at a maximum out-of-pocket fee of $119 (if needed).

    Fluoride treatments are offered as part of the appointment if the patient has broken teeth with or without root stumps. Fluoride treatments are recommended by the American Dental Association and help prevent tooth decay. Please note that care reports are left with the care community.

  • Fluoride Treatment... Included in your Medicaid Benefit.

    Fluoride treatments are offered with each dental cleaning as part of the appointment. Fluoride treatments are recommended by the American Dental Association and help prevent tooth decay. Please note that care reports are left with the care community.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Image field 138

  • ACKNOWLEDGEMENTS AND AUTHORIZATIONS

    1. As part of my completed enrollment, I acknowledge that I have received a copy of Sound Dental Care's Patient Bill of Rights, Health Insurance Portability and Accountabilty Act (HIPAA) Notice of Privacy Practices, Emergency Planning Handout, and our Patient Satisfaction Survey or I have reviewed said materials at the Sound Dental Care website. Specific links to these important materials are provided below.
    2. As part of my completed enollment, I acknowledge and understand that I can discontinue service at any time and will not be charged for cancellations or appointments should a resident refuse treatment.
    3. As part of my completed enollment, I affirm that I am authorized to coordinate the care for the patient.
    4. With regard to the dental care authorized in this completed enrollment, I affirm that I am responsible for payment on dental services rendered. Residents that qualify for Medicaid will only be charged for services authorized by Medicaid unless otherwise discussed with and consented to by the resident and/or POA. The responsible party identified above is not financially liable for services that Medicaid fails to cover. Sound Dental Care assigns all dental claims to our rendering provider, Sarah Luetke, PLLC DBA Sound Dental Care. As part of this authorization, the responsible party is acknowledging that dental invoices will come directly from Sarah Luetke, PLLC DBA Sound Dental Care with Sound Dental Care markings and that all dental payments will be submitted directly to Sarah Luetke, PLLC DBA Sound Dental Care. I acknowledge that Sarah Luetke, PLLC DBA Sound Dental Care may contact me about the resident’s dental care, the responsible party's billing preferences, and any issues surrounding insurance coverage. Please note that care reports are left with the care community.

  • PATIENT BILL OF RIGHTS & RESPONSIBILITIES

  • It is important that patients understand their rights. You have the right to...

    • Be fully informed in advance about the care and service to be provided, including the disciplines that furnish care and the frequency of visits, as well as any modifications to the plan of care/treatment.
    • Be informed of your financial responsibility in advance of the care or service to be provided.
    • Receive information about the scope of services that will be provided and the specific limitations on those services.
    • Communicate with Sound Dental Care and your care community regarding your treatment plan.
    • Refuse care or treatment after the consequences of refusing care or treatment are fully presented.
    • Have your property and person treated with respect, consideration, and recognition of your dignity and individuality.
    • Be able to identify visiting Sound Dental Care staff and associates through proper identification.
    • Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source and misappropriation of your property.
    • Voice grievances/complaints regarding your care or a lack of respect for your property. You have the right to recommend changes in policy, personnel, or your care without restraint, interference, coercion, discrimination, or reprisal.
    • Have grievances and complaints regarding your treatment properly investigated. Your right to have grievances and complaints investigated also applies to a failure to provide a treatment and to a lack of respect for your property.
    • Expect confidentiality and privacy of the information in your patient record and Protected Health Information (PHI).
    • Be advised of Sound Dental Care's policies and procedures regarding the disclosure of clinical records.
    • Be informed if there is any financial connection between Sound Dental Care and a provider that Sound Dental Care refers to.
    • Receive appropriate care without discrimination.
    • Be fully informed of your responsibilities.
    • Choose your dental provider.

    As Sound Dental Care collaborates with you on your care, patients and POAs are responsible for...

    • Submitting forms that are necessary to receive care and services.
    • Providing accurate medical and contact information and any changes.
    • Notifying your treating provider of participation in the care and services provided by Sound Dental Care.
    • Notifying Sound Dental Care about any concerns about the care and services provided.

    Learn more at www.sounddentalcare.com/patient-bill-of-rights

  • HIPAA NOTICE OF PRIVACY PRACTICES

    It is our duty to maintain the privacy and confidentiality of your protected health information (PHI). Anyone on the Sound Dental Care team can provide you with a printed or an emailed copy, or you can review the information on our website. Learn more about our HIPAA practices at www.sounddentalcare.com/hipaa-notice

  • EMERGENCY PLANNING CONSIDERATIONS

    Sound Dental Care maintains a robust Emergency Preparedness Plan to keep our patients and staff safe. We feel it is important to help our patients plan their actions should an emergency occur. Anyone on the Sound Dental Care team can provide you with a printed or an emailed copy, or you can review the information on our website. Learn more about emergency planning at www.sounddentalcare.com/emergency-planning

  • PATIENT SATISFACTION SURVEYS

    It is our desire to provide you with a 5-star level of service. In order to help us maintain our high standards, we encourage our patients, POAs, and guardians to periodically tell us how we are doing by completing a Patient Satisfaction Survey. We can provide you with a printed survey or you can complete one on our website at the link above. We will remind you about this opportunity on our invoices and care reports. Please note that we do not use surveys for marketing purposes and your responses are not released to the public. Surveys help us understand if an appointment went particularly well or if you have suggestions for improvement. If you have a grievance or complaint, please review the information in the following paragraph. Learn more at www.sounddentalcare.com/survey

  • GRIEVANCE OR COMPLAINT PROCEDURE

    A patient or caregiver may lodge a complaint without concern for reprisal, discrimination, or unreasonable interruption of service. To place a grievance, please call (206) 745-3808 to discuss your concern. Sometimes a short call is the best remedy to a misunderstanding. If your complaint is not resolved to your satisfaction within 5 working days, you may initiate a formal grievance, in writing and mail it to our practice. If you wish to initiate the formal process online, please complete the form on our website at the link above. You also have the option of calling the Accreditation Commission for Health Care (ACHC) at (919) 785-1214 or contacting the Washington State Department of Health. Learn more at www.sounddentalcare.com/feedback

  • If you have a complaint, you also have the option of contacting the Washington State Department of Health at the following link:

    https://doh.wa.gov/licenses-permits-and-certificates/complaint-and-disciplinary-process

  • GENERAL INFORMED CONSENT

    We feel that keeping the patients and POAs informed about our process is one of our most important jobs. We take this responsibility so seriously that we require your informed consent to the information outlined in the sections listed below.

  • Section A - Authorization to Obtain Medical Records

    I authorize Sarah Luetke, PLLC DBA Sound Dental Care and its network of providers to obtain the resident's medical records from the care facility for the purpose of providing dental care. With my completed enrollment, I provide my general informed consent and authorize Sarah Luetke, PLLC DBA Sound Dental Care to request, record, and archive the resident’s diagnoses, current medications, historical medications, and history of healthcare providers.

    Section B - Authorization to Coordinate Care with Primary Care Provider

    I authorize Sarah Luetke, PLLC DBA Sound Dental Care to obtain authorization for dental services from the resident’s physician of record or from the facility’s medical staff if dental services are authorized in the Care Selection section.

    Section C - Process for Dental Referrals

    Sound Dental Care clinicians are employed by Sarah Luetke, PLLC DBA Sound Dental Care. They are uniquely qualified to provide preventative dental services and the medical management of dental health. Sound Dental Care also maintains a network of denturists that are on hand to deliver full dentures and partial dentures without needing to leave the facility in some locations. If the patient resides in a skilled nursing facility or adult family home, and our clinical team finds an area of concern that may warrant offsite care, the Sound Dental Care staff will leave a detailed report and referral information with the facility. If a patient resides in an assisted living facility, a member of our staff will contact the legal decision maker when Sound Dental Care is recommending offsite care. If a patient is able to leave the facility, Sound Dental Care does recommend an annual exam with his or her dentist of record. Sound Dental Care does not provide crowns, bridges, root canals or extractions in the facility given that these procedures often carry additional risk for elderly/medically frail patients. If these types of procedures are required, Sound Dental Care will work with patients, families, and facilities to connect the patient with a dentist in the local community to ensure that the health and safety needs of the patient are being met. Emergent care will be coordinated between the primary care provider and a local dentist.

     

    Please sign below to complete your enrollment!

  • The person assisting the patient with enrollment obtained the consent of the person authorizing the care.  The person authorizing the care was thoroughly briefed on the content of the enrollment and provided with options to receive a copy of the completed enrollment.  To send a confirmation of the enrollment, please choose a confirmation option from the pull-down menu.

  • Thank you for letting us know that you would like us to send you a copy of your enrollment in the mail!  We will send the enrollment paperwork to the address provided in the Responsible Party section.  If you did not provide a responsible party address, you can press "Back" until you get to the Responsible Party Address fields.  The information you have already entered will not be lost.

  •  - -
  • Image field 139
  • Should be Empty: