Understanding Your Bill
Facility charges vs. professional charges
(why is the same code listed twice on my bill/estimate)?
- Facility charges cover the cost of operating the healthcare facility.
- Professional charges cover services provided by individual healthcare practitioners.
- Your visit may include care from providers who will send a separate bill. Those providers' contact information are included in a list here for your convenience:
Total charges vs. contracted rate
- Total charges are the same for all patients; however, your out-of-pocket cost may vary depending on your coverage, benefits and the location where services are provided.
- Contracted rates (allowed amounts) are the maximum your insurance pays for specific services. These amounts vary by plan and may change over time.
Self-pay
If you don’t have insurance, you’ll be billed at a preset rate for services.
- You’re responsible for the full cost of care.
- Payment plans are available to help manage costs.
Understanding Your Statement
The example below shows how to read your patient statement and find important details about your bill.
- Guarantor Name & Address - The name and address of the person or entity responsible for the bill.
- Guarantor ID - The identifier for the person or entity responsible for the bill.
- Account Name - The name of the patient who received services.
- Statement Date - The date the statement was sent to the patient.
- Due Date - The date payment must be received by the billing institution.
- Hospital Account Number (HAR) - The unique account identifier for the patient visit.
- Services Provided - The name of the service received by the patient.
- Insurance Payments - The portion of the cost insurance has paid for services.
- Contractual Allowance - The amount discounted when insurances have contracts with the billing entity.
- Patient Cost - The out-of-pocket cost to the patient after insurance has reviewed and paid their portion.
In-Network vs. Out-of-Network Benefits
In-Network Providers
In-network providers are healthcare professionals and facilities that have contracts with your insurance company to offer services at discounted rates. This means they agree to accept lower fees for their services, which helps keep your costs down.
- You’ll usually pay lower copayments, coinsurance and deductibles when you use in-network providers.
- Staying in-network helps keep your overall healthcare costs down.
Out-of-Network Providers
Out-of-network providers do not have a contract with your insurance company or are outside of your coverage area.
- You may pay higher out-of-pocket costs or be billed the full price for services.
- Copayments, coinsurance, and deductibles are typically higher when using out-of-network providers.
Understanding Your Out-of-Pocket Cost:
Example:
Patient has a $25 copay, $1,000 deductible, 20% co-insurance, $3,500 out-of-pocket max.
Contracted rate for procedure is $1,750, no payments made toward plan yet.
Price Definitions:
Copay
Fixed out-of-pocket amount you pay for service. Copays will vary by service type.
Co-Insurance
Your share of the cost for healthcare services after you’ve met your deductible.
Deductible
The amount you must pay each year before your insurance starts covering medical expenses. Deductible amounts vary by insurance plan and may apply to specific services.
Out-of-Pocket Maximum
The most you’ll pay for covered health care services in a plan year before your insurance pays 100% of covered costs for the rest of the year.
Explanation of Benefits (EOB)
A document your insurance company sends after you receive care. It explains the services provided, total costs, the amount paid by your plan, and what you owe.
Insurance Premium
The regular payment you or your employer make to your insurance company to maintain your policy.
Network
A group of doctors, hospitals, and other healthcare providers that have contracts with your insurance company to offer services at discounted rates.
Out of Network
Providers or facilities not contracted with your insurance company. You’ll typically pay higher costs when using out-of-network providers.
