Commercial Insurance Plans
Commercial health insurance is a type of health benefit that is usually employer-sponsored or privately purchased.
UW Medicine accepts these commercial insurance plans and can bill most of them for you. It is your responsibility to provide UW Medicine staff with your insurance coverage information, and to notify them if you experience a change in your insurance coverage.
Following your visit, your insurance or other health plan indicated at registration will be billed.
Many insurance companies pay at a different rate for “in-network” providers versus “out-of-network” providers. In-network providers make agreements with insurance companies to provide their services for pre-negotiated rates. Out-of-network providers are not contracted by your insurance company, and you may be responsible for paying in full or at a higher percentage. If you have questions about whether a physician or hospital is in-network or out-of-network, please contact your insurance carrier.
Patients who are responsible for a portion of their bill will be sent an itemized statement of charges for the services received at the UW Medicine clinic. This statement will be sent to the person listed as the "guarantor" on the patient’s account. The guarantor, who may or may not be the patient, is the person responsible for the bill. We kindly request that all statements be paid upon receipt, or within 30 days at a maximum.
Please note that for third-party liability cases such as automobile accidents, the patient or his/her guarantor are responsible for payment. UW Medicine will not hold open accounts until settlement is reached with a third-party payer.
Explanation of Benefits
After processing your claim, most insurers send you an Explanation of Benefits (EOB) that explains what portion of the bill is covered by insurance, and what portion is patient responsibility. If you have questions about your EOB, please contact your health plan.
Urgent Care Fees
Insurance companies process urgent care fees differently than fees for a primary care visit. You may have a higher patient responsibility for an urgent care visit (available through
UW Neighborhood Clinics and
Valley Medical Center) than you would for a primary care appointment. Some urgent care visits also require prior authorization from the health plan. For more information on how urgent care visits may be billed, and whether or not prior authorization is required, please contact your insurance carrier.
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
The different parts of Medicare help cover specific services:
Medicare Part A covers inpatient hospital care.
Medicare Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Part A and Part B benefits, sometimes referred to as "Original Medicare", are directly covered by Medicare itself.
Medicare Part C, called Medicare Advantage, is a type of Medicare health plan offered by commercial insurance companies that contracts with Medicare to provide you with all your Part A and Part B benefits, plus benefits that Original Medicare does not cover. The additional benefits vary among plans, but may include features such as dental care, gym memberships, and vision care. You can also select a Medicare Advantage plan that includes prescriptions. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you are enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare coverage. Some Medicare Advantage Plans offer prescription drug coverage.
If you purchase a Medicare Advantage plan, you may pay a monthly premium and a percentage of some costs. You will also be required to continue paying for your Medicare Part B premium.
Medicare Part D provides prescription drug coverage.
Please refer to
www.medicare.gov (a federal government website managed by the U.S. Centers for Medicare & Medicaid Services) for additional information on Medicare.
Medicaid is a jointly funded federal and state health insurance plan administered by states for low income adults, pregnant women, children and people with certain disabilities. Medicaid will pay for 100% of covered medical expenses. You must meet certain criteria to qualify. To see if you qualify, contact your local health department or social services office for an application or contact our Financial Counseling department at Harborview Medical Center at 206.744.3084 or at the University of Washington Medical Center at 206.598.2000. You may also
find out if you qualify for Medicaid at
www.healthcare.gov, a federal government website managed by the U.S. Centers for Medicare & Medicaid Services.
How can I get health insurance?
If you need to obtain insurance coverage, go to
wahealthplanfinder.org or call 1.855.923.4633 for information about how to enroll for Classic Medicaid, an Expanded Medicaid program for Washington State called Apple Health, and the various qualified insurance programs available to the public.
Is Financial Assistance available?
Yes, UW Medicine offers a Financial Assistance program for the underinsured and uninsured if you need help with your bill. If you would like more information to see if you qualify, you can refer to http://www.uwmedicine.org/financialassistance or contact the UW Medicine Financial Assistance location you are seeking or have received care.
Can I still be seen if I don't have active health insurance?
Uninsured or self-pay patients may be required to pay a deposit towards your scheduled, non-emergent visit. Please ask at the front desk or call the appointment line at 206.520.5000 to find out if a deposit is required and how much the deposit will be. Acceptable forms of payment include personal checks, Visa, MasterCard, American Express and Discover Card. You will be billed for any charges that exceed your deposit.