Fees and Insurance/Dental Records

 

The University of Pittsburgh School of Dental Medicine (SDM) will submit your dental claim(s) to your insurance company. You are ultimately responsible for all treatment provided at the SDM. You will be billed for the balance due after your insurance makes payment or denies your claim(s). The SDM is not responsible for interpreting your insurance benefits; we will submit for pre-authorization if you like or if your insurance company requires it. You are responsible for making timely monthly payments; failure to do so may result in discontinuance of your treatment and will result in further collection activity.

Listed below is a general guideline of insurance plans. You may contact your case manager, insurance company, or employer for benefit information.

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Medical Assistance
Medical Assistance will only pay for services they deem as covered, if you are eligible for benefits. You are responsible for non-covered services if you agree to the treatment. Services requiring prior authorization will not be provided until the SDM receives approval. If you decide to receive treatment for non-covered services, you are responsible for adhering to the SDM’s down payment and monthly payment schedules. Medical Assistance will not cover x-rays, prophylaxis, or an examination if you have received these services elsewhere in the recent past; therefore, you will be billed for these services, if denied.

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Concordia Plus and Dental Maintenance Organizations

The SDM will bill your insurance provider for services, if you have chosen us as your primary dental provider. You are responsible for denied or non-covered services, co-payments, and/or deductibles. Services requiring prior authorization will not be provided until the SDM receives approval from your insurance carrier. You are responsible for adhering to the SDM’s down payment and monthly payment schedules.

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Commercial Insurance, United Concordia, and Concordia Flex

The SDM will bill your insurance for services provided by the SDM. You are responsible for denied or non-covered services, as well as down payment and monthly payment schedules.

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Worker’s Compensation

An authorization must be obtained from your worker’s compensation carrier prior to scheduling an appointment at the SDM. We will submit your claim; however, you are ultimately responsible for payment for treatment denied by your worker’s compensation carrier or your dental insurance carrier.

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Automobile Insurance

If your dental treatment is related to your automobile accident, your automobile insurance will cover your related treatment in full, up to your policy maximum. All non-covered treatment is your responsibility. The SDM will submit your claim to your dental insurance carrier for all non-covered or denied treatment. If your dental insurance is a DMO or PPO, it is your responsibility to obtain pre-approval or pre-authorization.

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Federal Employee Program
See Commercial Insurance, as noted above.

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Medicare
Medicare does not cover dental treatment.

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Self Pay

Payment is expected for all treatment rendered by the SDM at the time of service, including an exam or radiograph. However, once a treatment plan has been established, payment arrangements may be made.

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Dental Records

The School of Dental Medicine (SDM), as the dental provider, has the prime custodial rights to every patient record. Each patient has a property right to personal health information and the privilege of reasonable access. Requests for personal health information are processed through the Dental Records Request Line. This line can be accessed by dialing (412) 648-8389. Records cannot be released without patient authorization. Original dental records must remain with the SDM. A fee is charged for the duplication of a patient’s radiographs, progress notes, and treatment plan.  Fees must be paid prior to release of dental records. By law, the University has 30 days to provide dental records from the time the proper authorization and payment is received.

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