Understanding Your Bill
Thank you for choosing Phoenix Children’s Hospital for your child’s medical care. When your child is in the hospital or seeing a specialist, you should focus on helping him or her get better. We understand that medical bills can be a concern and we’d like to help by providing information and answers to the questions that we hear most often regarding billing.
Scheduled Hospital Stays
When your child is scheduled for services at Phoenix Children’s Hospital, a member of our pre-registration team will contact you by phone 3 to 5 days prior to your appointment. During this call, we’ll ask you some basic questions about your child, the parent or guardian responsible, and about your insurance coverage. The Pre-Registration Process will enable our team to obtain prior authorization with your insurance, if needed, and to provide you with an estimate for charges and any payments due at the time of service. We will bill your insurance company for you.
Emergency Department Visits
If you have an emergency, you will be asked to complete registration when you arrive at our Emergency Department. We will ask you some basic questions about your child, the parent or guardian responsible, and about your insurance coverage. This will enable our team to alert your insurance carrier and determine the portion of the bill you are responsible for. We will bill your insurance company for you.
Doctors’ Appointments or In-Office Procedures
When you call for an appointment with a Phoenix Children’s Medical Group (PCMG) doctor, the scheduler will ask you some basic questions about your child, the parent or guardian responsible, and about your insurance coverage. Your portion of the payment for the office visit is due at the time of service. We will bill your insurance company for you.
We will file an insurance claim for you. That’s why it’s so important to have your complete and current insurance information on file with Phoenix Children’s Hospital. Please bring your insurance card with you every time you visit.
You may request an itemized billing statement that details the services provided by Phoenix Children’s Hospital and/or Phoenix Children’s Medical Group. To request an itemized billing statement that details the services provided by Phoenix Children’s Hospital and/or Phoenix Children’s Medical Group call 1-855-298-6377 any time Monday through Friday, 8 a.m. to 5 p.m Arizona time.
You will receive two separate billing statements: one for hospital services and one for physician services. You may also receive separate bills from doctors or other providers that assisted in your child’s care. These may include emergency physicians, anesthesiologists, radiologist, home health services, hospice, pathologists or other specialists. Why? Some of these doctors may be independent (not employed by Phoenix Children’s) and/or their services may have different arrangements with your insurance carrier. We all work together to provide excellent care for your child.
Specialty and Urgent Care Center Services
Phoenix Children’s offers care close to home at Specialty and Urgent Care Centers across the Valley. These centers are Hospital-based Clinics, meaning they are part of Phoenix Children’s Hospital. Certain services may result in separate bills for hospital-based services and physician services. Examples include imaging studies and lab work – in addition to receiving a bill from the doctor that treated your child, you’ll receive a bill from Phoenix Children’s Hospital for these and other hospital-based services provided. Urgent Care services will result in one bill for all Phoenix Children’s services used.
If you see the General Pediatricians at Phoenix Children’s Hospital for your child’s primary care, please be sure your insurance contracts with these doctors and list the doctor as your child’s primary care physician.
For specialty care visits (appointments with a pediatric specialist) in our hospital based clinics, you will receive two separate billing statements: one for hospital services (facility charge) and one for physician services (professional fee). Most Phoenix Children’s specialty care clinics are Hospital-based, meaning they are part of Phoenix Children's Hospital.
At times your physician may determine the need to evaluate your child’s condition or determine the need for possible admission to the hospital as an inpatient. Although your child may be staying in the hospital overnight, he/she is an OUTPATIENT of the hospital. As a patient in Observation status, your insurance will pay on an outpatient basis and you may be responsible for any out of pocket expenses such as copayments and deductibles, in accordance with your specific insurance plan. If at a later time your physician determines that your child should be admitted to the hospital as an inpatient, we will notify you of this change from outpatient to inpatient status.
No one should delay seeking necessary medical care due to insurance or cost concerns. If you need help understanding your insurance benefits, want more detail regarding estimated charges, or need to make financial arrangements to pay for your portion of the bill, Phoenix Children’s offers Financial Counselors, who are available seven days a week (Monday through Friday 8 a.m. to 8 p.m. and Weekends 8 a.m. to 4:30 p.m. Arizona time).
This dedicated team will help you understand the benefits you’re entitled to and, if eligible, assist you in applying for commercial insurance or AHCCCS coverage. If you cannot afford to pay your bill after all payers have processed your claim(s), we will help you apply for financial assistance from Phoenix Children’s. We will advise you of the documentation required to receive financial assistance.
What should I do if I think there’s a mistake on my bill?
Please contact the Phoenix Children’s Hospital billing office at 1-855-298-6377
What is a deductible?
A deductible is the amount of money you must pay before your insurance company begins covering part or all of your medical expenses. Check your insurance coverage details to confirm the amount of your deductible. Deductibles may apply to any hospital service performed at Phoenix Children's Hospital including hospital stays, Specialty and Urgent Care, or Outpatient visit.
What is co-insurance?
After you meet your deductible, co-insurance is a set percentage of the insured medical expenses that you may be required to pay. Check your insurance coverage details to confirm your co-insurance percentage.
What is a co-payment?
This is a set payment you make every time you receive a medical service, according to your insurance coverage. Check your insurance coverage details to confirm the amount of your co-payment, which is due when you receive services.
Can I get an estimate of what services will cost before my visit?
Yes, our Pre-Access Department can provide an estimate of the cost of medical services in advance. If you receive treatment in the Emergency Department, our Financial Counseling Department can provide this information for nonscheduled services.
Why are some of my hospital bills covered by insurance and some are not?
Hospital coverage often has a deductible or out-of-pocket expense you are responsible for paying before full coverage applies. Because each insurance plan is different, please review your benefits carefully and contact your insurance company if you have questions about coverage or eligible expenses.
Why did I get two bills for my child’s hospital stay?
In order to comply with Centers for Medicare and Medicaid Services and insurance industry regulations, Phoenix Children’s Hospital bills for both facility and professional services. So when you visit Phoenix Children’s Hospital or one of our clinic sites you may receive more than one bill. The bill you receive from Phoenix Children’s is for use of our facility (facility charges). The physicians, radiologists and other specialists, may bill you separately from their own practices (professional fees). We all work together to provide excellent care for your child.
What is a Facility Charge?
A facility charge covers the cost of running the facility (hospital or clinic). This includes supplies, equipment, exam rooms and non-physician staff. The facility charge varies based on whether your child is a new or established patient, the type of visit, and the hospital resources required to effectively treat your child.
Why is there a Facility Charge for clinic visits and urgent care?
PCH specialty and urgent care centers are licensed by the state of Arizona as Hospital-based Clinics. These centers are part of the Phoenix Children’s facility, with the same services and amenities provided at the main campus. Thus they incur the same facility charge as a visit to the main campus. This is a standard practice for most other hospital-based clinics across the country.
Will my insurance cover the Facility Charge?
This varies by insurance carrier. Some insurance companies cover the entire charge; others cover a percentage. It’s best to check first with your insurance company on their coverage of hospital-based clinic facility charges so you will know what to expect.
What is a Professional Fee?
This is the bill from the doctor(s) who treated your child. When your doctor works directly for PCH, the bill will come from Phoenix Children’s Medical Group (PCMG). However, we have many doctors on our Medical Staff, who meet our rigorous requirements for training and experience, but are not employed by Phoenix Children’s. You will receive a bill directly from their practice for their professional fees. Depending upon the complexity of your child’s condition and the services provided, you may receive bills from multiple physicians.
Who should I call if I have questions about a bill I’ve received?
If you have questions about your bill, please contact the specific provider at the number listed on their billing statement.
Can I pay my bill online?
Yes, Phoenix Children’s Hospital now offers online bill pay.
Our commitment is to ensure you understand the registration, admitting, billing and financial assistance processes at Phoenix Children's Hospital. Financial counselors are available Monday through Friday, 6 am to 8 pm and weekends 8 am to 4:30 pm in Main Admitting. You may also call us toll-free for any questions about your bill at 1-855-298-6377.
|Financial Counselors||(602) 933-2000|