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A Price Estimate is an estimate of a patient’s financial liability for a service provided at a UPMC facility by a UPMC physician.
UPMC can provide Price Estimates for scheduled services provided at a UPMC facility, excluding dental and emergency services. We also handle durable medical equipment (DME) and home health services separately. If you need an estimate for DME or home health, please call UPMC’s DME and home health provider for more information:
A Price Estimate is calculated using the patient’s demographic information, insurance benefit accumulation, insurance allowable amounts, procedure and/or procedure code(s), and facility in which the services will be provided.
UPMC does not have pricing information, nor do we provide estimates, for services at non-UPMC facilities. UPMC prices can vary based on location, such as with urban vs. rural facilities (e.g., UPMC Presbyterian vs. UPMC Bedford).
A Price Estimate may differ from the actual bill for several reasons. The patient’s benefit accumulation may vary between the estimate date and the service date, or non-scheduled services may be provided in addition to the estimated services (e.g., lab work, office consultation, additional radiology). Add-on charges (e.g., contrast, anesthesia) that cannot be predicted also may affect the total patient financial liability. If your bill is $400 or more higher than your estimate for the same service, you can initiate a dispute resolution process, see below.
You can initiate the patient-provider dispute resolution process if the difference between the price estimate and the bill from any single provider or facility is at least $400 and the bill is dated within the last 120 days. There is a $25 fee to use the dispute process. If the Selected Dispute Resolution (SDR) entity reviewing your dispute agrees with you, you will have to pay the price on this price estimate, reduced by the $25 fee. If the SDR entity disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers, call 1-800-985-3059 or email FederalPPDRQuestions@cms.hhs.gov.
Determination of preventive vs. diagnostic services depends on the services rendered by your physician at the time of service. If your physician determined that diagnostic services were required based upon your condition, they will be billed and paid as diagnostic.
CPT, or Current Procedural Terminology, is a universal billing code that describes health care services rendered.
The insurance-allowable amounts are contracted rates agreed upon by the insurance payers and UPMC. A total charge estimate can be obtained upon request.
Please contact UPMC at 1-833-298-7316 to provide your insurance information.
A new Price Estimate request may be submitted by calling 1-833-298-3716.
Payment may be made prior to service, at the time of service, or after a statement has been received.
UPMC offers financial counseling services and payment options for our patients, including interest-free payment plans. Payment plans are monthly and can be set up for automatic deduction from a bank account. UPMC can also assist patients in applying for Medical Assistance (Medicaid) prior to the service or UPMC Financial Assistance once a bill is received. Please contact our Patient Financial Service Center at 1-833-298-3716.
We appreciate your concerns. Questions related to your treatment are best discussed directly with your UPMC provider. Please note that UPMC does have financial options to help you manage care costs. You may call our Patient Financial Services Center at 1-833-298-3716.
You may cancel a scheduled service at UPMC by contacting the number you used to schedule the appointment. However, we certainly would not want the cost of services to interfere with your treatment plan recommended by your physician. Please reach out to your physician to discuss options or call our Patient Financial Services Center at 1-833-298-3716.
