Our Billing Process

Just like with medical care, our goal at Phoenix Children’s is to make the billing process as easy and effective as possible. Review billing and payment steps, so you know what to expect. As always, we’re here if you have questions.

Step One: Register at Phoenix Children’s

Before a patient receives care, we’ll ask some basic questions about them and their health insurance coverage. The registration process is slightly different based on the type of care a patient needs.

Scheduled Hospital Stays

When a patient has scheduled hospital services at Phoenix Children’s, a member of our pre-registration team will contact you by phone three to five days before the appointment. During this call, we’ll ask basic questions about the patient, the parent or guardian responsible and your insurance coverage. This process is called pre-registration. It allows our team get approval from your insurance company before you or your child receive medical services (called prior authorization), if needed. It also helps us estimate charges and any payments due at the time of service. We’ll bill your insurance company for you after you receive services.

Emergency Department Visits

For emergencies, you’ll need to complete registration when you arrive at our Emergency Department. We’ll ask basic questions about the patient, the parent or guardian responsible and your insurance coverage. This process allows us to alert your insurance company and determine how much of the medical bill you’re responsible for paying. We’ll bill your insurance company for you after you receive services.

Doctors’ Appointments and In-Office Procedures

When you call for an appointment with a doctor at Phoenix Children’s Medical Group, the scheduler will ask basic questions about the patient, the parent or guardian responsible and your insurance coverage. We’ll bill your insurance company for you after you receive services. Your portion of the payment for the office visit is due at the time of service.  

Step Two: Your Insurance Company Is Billed

After a patient sees us, we file an insurance claim. Having your current insurance information on file with Phoenix Children’s is important, so we bill the correct insurance company. Make sure you bring your insurance card with you every time you visit.

Based on what your insurance plan covers, you’ll receive a bill from us with the remaining balance.

Step Three: Receive and Pay Your Bill

The medical bill or bills you receive may look different depending on the type of visit or procedure. Billing amounts are based on medical rules and regulations and depend on the status of your visit. Some visits may have more than one status. You will receive information about billing and visit status in writing.

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Bills for Hospital Stays

For inpatient hospital stays, you will receive one billing statement. It will have a few bills that you’ll pay separately. You may see charges for the following:

• Hospital services (facility charge)
• Physician services (professional fee) – You may receive bills from doctors or other providers if they helped with patient care. Examples include emergency physicians, anesthesiologists, radiologists, home health services, hospice providers, pathologists or other specialists. Some of these doctors may be independent (meaning they don’t work for Phoenix Children’s), so they may have different agreements with your insurance company – even though we all work together to give patients excellent care.

Bills for Specialty and Urgent Care Center Services

At Phoenix Children’s, we offer 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. Patients who get care at these centers will receive one billing statement but may have separate bills to pay for hospital-based services and physician services.

For example, if your child sees a provider and has blood drawn (lab work), you’ll receive one billing statement with:

• A bill from the doctor who treated your child
• A bill from Phoenix Children’s for the lab work, as well as any other hospital-based services

For urgent care, you’ll receive one bill for all Phoenix Children’s services used.

Bills for Outpatient Visits

If you see the general pediatricians at Phoenix Children’s for primary care, be sure your insurance company contracts with these doctors. List the doctor as the patient’s primary care physician. You’ll receive one billing statement for primary care visits.

You’ll also receive one billing statement for specialty care visits (appointments with a pediatric specialist) in our hospital-based clinics. There will be two bills on the statement: one for hospital services (facility charge) and one for physician services (professional fee). Most of our specialty care clinics are hospital-based, meaning they are part of Phoenix Children’s.

Bills for Observation Services

Sometimes, you or your child may stay overnight at the hospital under “observation status.” Observation status is when your doctor needs to evaluate a patient’s condition or see if they’d benefit from admission to the hospital as an inpatient. Although a patient may stay at the hospital overnight, they’re still considered an outpatient.

With observation status, your insurance will pay on an outpatient basis. You will be responsible for any out-of-pocket expenses, such as copayments and deductibles. If, at a later time, your doctor confirms that you or your child should be admitted to the hospital as an inpatient, we’ll notify you of the change from outpatient to inpatient status. Your billing statement will reflect any status changes.