Terms and Conditions

Last Updated: January 24, 2025

Welcome to Global Dental Claims. By accessing or using our services, you agree to be bound by the following Terms and Conditions. Please read this document carefully to understand your rights, obligations, and the scope of services provided by Global Dental Claims.

1. Consent for Reviewing Claims

By engaging Global Dental Claims, you acknowledge and agree to the following:

Authorization:
- You authorize Global Dental Claims to review, analyze, and provide guidance based on the dental claims and supporting documents you submit.
- This authorization includes consent to access information provided by you or third parties to complete the evaluation process.
Accuracy of Information:
- You confirm that all documents and details submitted are accurate, complete, and truthful to the best of your knowledge. Inaccurate or incomplete information may affect the quality of our recommendations.
Scope of Service:
- Our services aim to assist you in understanding the status of your claims, identifying potential issues, and offering professional recommendations to improve claim outcomes.
- We do not submit claims directly to insurance providers, nor do we serve as legal representatives or advocates in disputes with insurance companies or providers.
Limitations of Review:
- Our recommendations are based on the policies and information available at the time of review. While we assist in resolving claim issues caused by existing insurance provider rules (e.g., coding errors, format issues, or frequency limits), we are not responsible for sudden or retroactive policy changes made by insurance companies.

2. Scope of Services

Free Services:

Nature of Free Claim Analysis:
- The free claim analysis provides general insights and recommendations on claim issues or denials.
- This service does not include direct claim submissions, appeals, or guarantees of claim approval.
What the Free Service Covers:
- Identification of common claim submission errors.
- Guidance on eligibility rules and claim policies.
- Recommendations for addressing potential issues with your insurance provider.
What the Free Service Does NOT Cover:
- Resolution of disputes caused by retroactive insurance policy changes or unpredictable actions by third parties.
- Comprehensive, detailed investigations that require extensive manual research (available under paid services).

Paid Services:

Our paid services include but are not limited to:
- Comprehensive claim reviews.
- Tailored consulting sessions on claim strategies.
- Detailed documentation and reporting for denied or complex claims.
- Insurance eligibility verifications.
The details, pricing, and deliverables of each service are outlined in your agreement or invoice.

3. Protection Clause: Limitation of Liability in Third-Party Disputes

Advisory Role Only:
- Global Dental Claims serves in an advisory capacity, providing professional recommendations based on the information available. We do not guarantee specific outcomes, including claim approval or reimbursement.
Third-Party Actions:
- If disputes arise between you and a third party (e.g., an insurance company or provider) based on our recommendations, you agree to release Global Dental Claims from any claims, lawsuits, or damages.
Member Responsibility:
- You are responsible for decisions made using our recommendations. Global Dental Claims is not liable for disputes, denials, or actions by third parties.
Cap on Damages:
- Our total liability is limited to the fees paid for the specific service provided. Under no circumstances will we be responsible for indirect, incidental, or consequential damages.

4. Ownership and Use of Reports

Intellectual Property:
- All reports, analyses, and materials provided by Global Dental Claims remain our intellectual property. You may use these materials for personal or internal purposes only.
Restrictions on Use:
- You may not modify, redistribute, or republish the materials without our prior written consent.
- Reports may not be used for litigation purposes against insurance companies or providers without explicit written approval.

5. Review Collection and Promotional Use

Feedback and Reviews:
- By using our services, you agree that Global Dental Claims may request feedback or reviews to improve our offerings.
Promotional Use of Reviews:
- Testimonials and success stories may be used for marketing purposes (e.g., website, social media). Any identifying information will only be used with your explicit consent.
Incentives for Reviews:
- We may offer discounts or other incentives for submitting reviews or referrals. These incentives will be outlined at the time of the offer.

6. Refund and Dispute Policy

Refund Requests:
- Refunds are issued only for services not delivered due to internal errors. Requests must be submitted within 7 days of service delivery.
- Refunds are not provided for errors caused by incomplete or inaccurate submissions from the client.
Dispute Resolution:
- Clients are encouraged to contact us directly with concerns. We strive to resolve disputes amicably.

7. Privacy and Data Protection

Data Security:
- We adhere to all applicable privacy regulations, including HIPAA, to ensure the secure handling of sensitive information.
Use of Client Data:
- Client information is used solely for claim reviews and consultations. It will not be shared with third parties without explicit consent.
For More Details:
- Please refer to our Privacy Policy for comprehensive information on data protection.

8. Governing Law and Arbitration

Applicable Law:
- These terms are governed by the laws of the State of Texas.
Arbitration:
- Disputes arising from these terms will be resolved through confidential arbitration in Houston, Texas, in accordance with the American Arbitration Association's rules.
Severability:
- If any part of these terms is deemed invalid, the remainder shall remain enforceable.

9. Contact Information

Global Dental Claims

Email: info@globaldentalclaims.com
Phone (US): +1 956-253-3725
Phone (Mexico): +52 833-694-7146
Website: www.globaldentalclaims.com

Customer Support Hours:
Monday–Friday, 9 AM–5 PM CST

10. Key Highlights (For Quick Reference)

Free Service: Includes general claim analysis and recommendations only.
Limitations: We do not guarantee claim approval, nor do we handle retroactive policy disputes.
Liability: Our role as an advisory service limits our involvement in third-party disputes and ensures that liability remains with the parties directly involved in the claim process.
Refunds: Available only for services undelivered due to internal errors.

HIPAA Privacy Practices.

Protected Health Information (PHI) is information, including demographic information, that may identify you and that relates to health care services provided to you, the payment of health care services provided to you, or your physical or mental health or condition, in the past, present or future. This Notice of Privacy Practices describes how we may use and disclose your PHI. It also describes your rights to access and control your PHI.

As a health plan advisor/consultant we are required by Federal law to maintain the privacy of PHI and to provide you with this notice of our legal duties and privacy practices.

We are required to abide by the terms of this Notice of Privacy Practices, but reserve the right to change the Notice at any time. Any change in the terms of this Notice will be effective for all PHI that we are maintaining at that time. If a change is made to this Notice, a copy of the revised Notice will be available to all individuals covered under the plan at that time.

Permitted Uses and Disclosures

Treatment, Payment and Health Care Operations

Federal law allows a health plan to use and disclose PHI, for the purposes of treatment, payment and health care operations, without your consent or authorization. Examples of the uses and disclosures that we, as a Dental Billing , may make under each section are listed below:

Treatment. Treatment refers to the provision and coordination of health care by a doctor, hospital or other health care provider. As a health plan we do not provide treatment.
Payment. Payment refers to the activities of a health plan in collecting premiums and paying claims under the plan for health care services you receive. Examples of uses and disclosures under this section include the sending of PHI to an external medical review company to determine the medical necessity or experimental status of a treatment; sharing PHI with other insurers to determine coordination of benefits or settle subrogation claims; providing PHI to the plan's UR Company for precertification or case management services; providing PHI to the plan's UR Company for pre-certification or case management services; providing PHI in the billing, collection and payment of premiums and fees to plan vendors such as PPO Networks, UR Companies, Prescription Drug Card Companies and reinsurance carriers; and sending PHI to a reinsurance carrier to obtain reimbursement of claims paid under the plan.
Business Associates
We contract with entities (known as "business associates") to perform various functions on our behalf or to provide certain types of services. Some of the functions they provide are administering claims, member service support, utilization management, subrogation, and pharmacy benefit management. To perform these functions or to provide the services, business associates will receive, create, maintain, use, or disclose protected health information, but only after we require the business associate to agree in writing to contract terms designed to appropriately safeguard your information.
Health Care Operations. Health Care Operations refers to the basic business functions necessary to operate a health plan. Examples of uses and disclosures under this section include conducting quality assessment studies to evaluate the plans performance or the performance of a particular network or vendor; the use of PHI in determining the cost impact of benefit design changes; the disclosure of PHI to underwriters for the purpose of calculating premium rates and providing reinsurance quotes to the plan; the disclosure of PHI to stop-loss or reinsurance carriers to obtain claim reimbursements to the plan; disclosure of PHI to plan consultants who provide legal, actuarial and auditing services to the plan; and use of PHI in general data analysis used in the long term management and planning for the plan and company.

Other Uses and Disclosures Allowed Without Authorization

Federal law also allows a health plan to use and disclose PHI, without your consent or authorization, in the following ways:

To you, as the covered individual.
To a personal representative designated by you to receive PHI or a personal representative designated by law such as the parent or legal guardian of child, or the surviving family members or representative of the estate of a deceased individual.
To the Secretary of Health and Human Services (HHS) or any employee of HHS as part of an investigation to determine our compliance with the HIPAA Privacy Rules.
To a Business Associate as part of a contracted agreement to perform services for the health plan.
To a health oversight agency, such as the Department of Labor (DOL), the Internal Revenue Service (IRS) and the Insurance Commissioner's Office, to respond to inquiries or investigations of the plan, requests to audit the plan, or to obtain necessary licenses.
In response to a court order, subpoena, discovery request or other lawful judicial or administrative proceeding.
As required for law enforcement purposes. For example to notify authorities of a criminal act.
As required to comply with Workers' Compensation or other similar programs established by law.
To the Plan Sponsor, as necessary to carry out administrative functions of the plan such as evaluating renewal quotes for reinsurance of the plan, funding check registers, reviewing claim appeals, approving subrogation settlements and evaluating the performance of the plan.
In providing you with information about treatment alternatives and health services that may be of interest to you as a result of a specific condition that the plan is case managing.

The examples of permitted uses and disclosures listed are not provided as an all inclusive list of the ways in which PHI may be used. They are provided to describe in general the types of uses and disclosures that may be made.

Other Uses and Disclosures

Other uses and disclosures of your PHI will only be made upon receiving your written authorization. You may revoke an authorization at any time by providing written notice to us that you wish to revoke an authorization. We will honor a request to revoke as of the day it is received and to the extent that we have not already used or disclosed your PHI in good faith with the authorization.

Your Rights in Relation to Protected Health Information

Right to Request Restrictions on Uses and Disclosures

You have the right to request that the plan limit its uses and disclosures of PHI in relation to treatment, payment and health care operations or not use or disclose your PHI for these reasons at all. You also have the right to request the plan restrict the use or disclosure of your PHI to family members or personal representatives. Any such request must be made in writing to the Privacy Contact listed in this Notice and must state the specific restriction requested and to whom that restriction would apply.

The plan is not required to agree to a restriction that you request. However, if it does agree to the requested restriction, it may not violate that restriction except as necessary to allow the provision of emergency medical care to you.

Right to Receive Confidential Communications

You have the right to request that communications involving PHI be provided to you at an alternative location or by an alternative means of communication. The plan is required to accommodate any reasonable request if the normal method of disclosure would endanger you and that danger is stated in your request. Any such request must be made in writing to the Privacy Contact listed in this Notice.

Right to Access to Your Protected Health Information

You have the right to inspect and copy your PHI that is contained in a designated record set for as long as the plan maintains the PHI. A designated record set contains claim information, premium and billing records and any other records the plan has created in making claim and coverage decisions relating to you. Federal law does prohibit you from having access to the following records: psychotherapy notes; information compiled in reasonable anticipation of, or for use in a civil, criminal or administrative action or proceeding; and PHI that is subject to a law that prohibits access to that information. If your request for access is denied, you may have a right to have that decision reviewed. Requests for access to your PHI should be directed to the Privacy Contact listed in this Notice.

Right to Amend Protected Health Information

You have the right to request that PHI in a designated record set be amended for as long as the plan maintains the PHI. The plan may deny your request for amendment if it determines that the PHI was not created by the plan, is not part of designated record set, is not information that is available for inspection, or that the PHI is accurate and complete. If your request for amendment is declined, you have the right to have a statement of disagreement included with the PHI and the plan has a right to include a rebuttal to your statement, a copy of which will be provided to you. Requests for amendment of your PHI should be directed to the Privacy Contact listed in this Notice.

Right to Receive an Accounting of Disclosures

You have the right to receive an accounting of all disclosures of your PHI that the plan has made, if any, for reasons other than disclosures for treatment, payment and health care operations, as described above, and disclosures made to you or your personal representative and pursuant to an authorization provided by you Your right to an accounting of disclosures applies only to PHI created by the plan after April 14, 2003 and cannot exceed a period of six years prior to the date of your request. Requests for an accounting of disclosures of your PHI should be directed to the Privacy Contact listed in this Notice.

Right to Receive a Paper Copy of this Notice

You have the right to receive a paper copy of this Notice upon request. This right applies even if you have previously agreed to accept this Notice electronically. Requests for a paper copy of this Notice should be directed to the Privacy Contact listed in this Notice.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the plan or the Secretary of Health and Human Services. Complaints should be filed in writing with the Privacy Contact listed in this Notice. The plan will not retaliate against you for filing a complaint.

Privacy Contact

Global Dental Claims Solutions LLC
36 Sam Perl Blvd Ste 139
Brownsvile, Texas 87520
support@globaldentalclaims.com

Effective Date of Notice

This notice published and becomes effective on April 14, 2003.

- Have questions? Reach out to us at info@globaldentalclaims.com

Simplify your dental insurance claims with our expert support. Schedule a free consultation to resolve claim issues and make the most of your benefits.

Phone Number :
US +1 (956) 253-3725

ITL+52 (833) 694-7146

Email: info@globaldentalclaims.com

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