The healthcare billing, payment and insurance process can be confusing. Below you’ll find frequently asked questions about your financial responsibilities before, during and after your physician visit.
General billing questions
Facility fees: If you receive services at a hospital, medical center, outpatient clinic or other location that is clinically integrated into the hospital, you will receive a bill for "facility fees" for its services, in addition to a bill for the professional fees for the provider’s services. Facility fees are charged for hospital stays, some clinic visits, and services such as X-rays, lab tests and therapies.
Professional fees: Your professional fee covers the services performed by physicians or other healthcare providers. This will include care you received directly, as well as interpretation of your medical and diagnostic tests. Professional fees are billed by UW Physicians (UWP) or Northwest Physicians.
Laboratory fees: If you receive laboratory services at a UW Medicine location that charges a facility fee, you will not receive a separate bill for your lab work because the facility bill includes the charges for the lab work. If you receive laboratory services at a UW Neighborhood Clinic, you will be billed separately for lab services because UW Neighborhood Clinics and Hall Health do not charge a facility fee.
A facility fee is charged for services given in a hospital-based outpatient clinic or location. This is a standard model for large healthcare systems like UW Medicine. Billing rules are different for hospital-based clinics than for clinics that are not part of a hospital.
All patient responsibility balances are due and payable 30 days from the date you receive your statement. If you are having difficulty paying your bill in full, you may arrange a payment plan. Financial assistance is available for qualified, underinsured and uninsured applicants. Learn more about UW Medicine's financial assistance program requirements here.
UW Medicine does not require a referral from an outside physician, but some insurance plans do require some form of referral. Check with your insurance to see if there are requirements to making sure your visit is covered.
Please note that for third-party liability cases such as automobile accidents, the patient or his/her guarantor is responsible for payment. UW Medicine will not hold open accounts until settlement is reached with a third-party payer.
It is your responsibility to notify the clinic of any changes to your name, address, phone number, employer, emergency contact name and/or insurance plan(s). Call us right away at the numbers below if your insurance information has changed since you last registered as a patient, or if you believe your claim may have been denied because of missing or incorrect billing or other personal information. We will update your account information and re-bill your insurance with your new information. Have your account number ready when you call.
Requirements for submitting claims to a medical savings account or healthcare reimbursement account vary. The two most common items of information needed, but not provided, on the facility bill or statement are: the physician’s or provider’s name and a diagnosis.
After your medical visit, UW Medicine will file claims for services rendered to your insurance plan(s). When your insurance has processed the claim, they will send you an Explanation of Benefits (EOB), telling you what services were billed, what amount was covered by the insurer and what balance you owe. The bill that follows in the mail (or electronically if you have selected to receive your statements this way) will be an itemized statement of charges and balance owed for services received at the UW Medicine clinic you visited. 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.
UW Medicine participates in many health insurance plans. However, UW Medicine is not included in all plans that each health insurance company offers. Please contact your health insurance plan to verify that your care at UW Medicine will be covered. You can also consult the list of health insurance plans and government programs in which UW Medicine participates.
Uninsured or self-pay patients may be required to pay a deposit towards a 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, and payment is expected at the time of service.
UW Medicine offers financial assistance for the underinsured and uninsured that need help with their bill. For more information and to see if you qualify, you can refer to https://www.uwmedicine.org/patient-resources/billing-and-insurance or contact the UW Medicine location you are seeking or have received care.
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.
Check with your insurance carrier to see if your provider is in network. Your insurance may 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.
Charges which may not be paid by your insurance and may then become your responsibility include:
- Co-insurance and/or co-pays
- Benefit limitations, i.e. items or services not covered under your insurance plan
- Medicare program exclusions (see your Medicare handbook for a complete listing).
- Check your explanation of benefits and/or contact your insurance company with your specific questions.
Insurance claims may also be denied because of missing or incorrect subscriber information on the claim. If you believe your claim was denied for this reason, please call us immediately. Have your explanation of benefits in hand when you call. We will update your account and/or re-bill your insurance.
Give the clinic your primary and secondary insurance information. If we have complete information, we can bill both insurances right away. This will make it easy for you to manage your bills.
Your insurance coverage will vary depending upon the services you receive. You should request the specific coverage and benefit detail from your insurance company ahead of time for all procedures and visits. You may contact the provider/clinic for an estimate if necessary.
Check with your insurance carrier to see if you have a copay or coinsurance payment. A copay is a set fee established by your benefit contract that you pay at the time of service. If you do have a copay, please bring payment with you to your visit.
A coinsurance payment is the amount you must pay after your insurance has paid its portion. In many health plans, patients must pay for a portion of the allowed amount. For instance, if the plan pays 70% of the allowed amount, the patient pays the remaining 30%.
The deductible is the amount a patient pays before the insurance plan pays anything. Check with your insurance carrier to learn the amount of your deductible. In most cases, deductibles apply per person per calendar year. Check with your insurance carrier to learn how close you are toward meeting your yearly deductible.
You will be asked a series of questions required by law at each visit regarding your status, including other insurance you may have, and your retirement date. If you are covered by Medicare, we will submit your claims to Medicare on your behalf.
Physician billing questions
We strongly encourage you to include your statement stub with your payment. This ensures that your payment will be applied correctly to your account. We rely on the statement stub to provide the information we need to properly apply the payment received to the correct account. If you have lost your statement stub, please include your account number or invoice number on the memo line of your check to help us properly apply your payment to your account.
As an academic medical center, we have different types of healthcare practitioners who provide services to patients but may not be noted on your bill. For example, you may have been seen by a resident or fellow who is supervised by an attending physician, and only the name of the attending physician is noted on your bill. Or your X-rays may have been evaluated by a physician that you never personally met, and their name will appear for those services.
Generally, this is a matter of timing; the statement was sent before we could get this information entered into our billing system. These payments should be noted on your next bill.
Please call customer service (see contact information above) if: Your coverage is not listed in the message box on your statement; the coverage is listed on your statement and you have not received an explanation of benefits (EOB) from your insurance company; the coverage is listed on your statement and you have received an Explanation of Benefits (EOB) from your insurance company, please contact them to determine why they did not pay in full.
Your privacy is our utmost concern. We have strict policies and procedures to ensure that we maintain your privacy. Because we do not, at this time, have the ability to communicate with you via a secure e-mail process, we are not able to answer billing questions via e-mail.
Please contact customer service. They will review the charges and medical records for the service/s in question and initiate the rebilling process, if necessary.
UW Physicians will honor Financial Assistance granted by the facility. Please contact our billing office as we may not have received notice regarding your Financial Assistance. We will update our system accordingly.
Collection agency questions
Please contact customer service for more information regarding your account. Your insurance may have been billed and this is the balance due after insurance (copay, co-insurance, deductible). Or we may require more information to bill your insurance.
As noted on your statements, your balance is due, in full, at the time of billing. Our billing system requires a formal payment plan to be entered to prevent a patient’s account from being referred to collections. Please contact customer service to discuss your options.