Billing & Financial Assistance
You may have a lot of questions about medical billing and terminology. Trust us – that’s normal. To help, we’ve answered some of the frequently asked questions (FAQs) we get about hospital bills.
Health Insurance Terms to Know
What is a deductible?
A deductible is how much money you must pay before your insurance company begins covering part or all your medical expenses. For example, if your deductible is $500, and you have $600 of medical expenses, you would pay $500. Your insurance may cover all or part of the remaining $100.
Check your insurance coverage details to confirm the amount of your deductible. Deductibles may apply to any hospital service, including hospital stays, specialty and urgent care, or outpatient visits at Phoenix Children's locations.
What is coinsurance?
Coinsurance is a set percentage of the insured medical expenses that you may be required to pay after you meet your deductible. For example, let’s say your medical bill is $100, and your insurance plan has 80/20 coinsurance. If you have already paid your deductible, your insurance will pay 80% of your bill ($80). You’d pay 20% of the bill ($20).
Review your insurance coverage details to confirm your coinsurance percentage.
What is a copayment?
A copayment, or copay for short, is a set payment you make every time you receive a medical service, according to your insurance coverage. For example, if your insurance plan has a $30 copay, you would pay $30 at each office visit or when you pick up a prescription.
Check your insurance coverage details to confirm the amount of your copayment, which is due when you receive services.
Medical Cost Estimates
Can I get an estimate before my visit of what services will cost?
Yes, for any scheduled visits, our Financial Clearance Center at Phoenix Children’s can give you an estimate in advance of how much medical services will cost. To request an estimate, call 602-933-6696 Mon. – Fri.: 8:30 am to 5 pm MT.
For unscheduled visits, such as in the Emergency Department, our financial counselors can provide this information.
If a patient spends the night at the hospital, will they be charged as an inpatient?
It depends. Sometimes, patients may stay overnight at the hospital under “observation status.” Observation status is when a patient’s doctor needs to evaluate their condition to see if they’d benefit from admission to the hospital as an inpatient. Although the patient may stay at the hospital overnight, they’re still considered an outpatient of the hospital.
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.
What is an outpatient surgery center, and why would I have a procedure done there instead of the hospital?
An outpatient surgery center is a location separate from a hospital’s main campus operating room where surgeons can provide services for their patients. Doctors decide the best location for surgery based on how complex the procedure is and the patient’s medical status.
Sometimes it can be less expensive when a procedure is performed at an outpatient surgery center instead of a hospital operating room. However, the cost depends on many factors, including the length of the procedure, materials, anesthesia and recovery time.
What if my doctor asks another doctor to visit my (or my child’s) hospital room? Will I be charged for that?
Primary care doctors often ask another doctor to check on patients while they’re in the hospital. If your doctor orders a specialty consult or any additional services (therapy, radiology or labs), they should explain them to you first. You can refuse to have the service.
You may receive two bills for this additional service: one from Phoenix Children’s and one from Phoenix Children’s Medical Group or an outside physician practice for the individual doctor’s time.
What is a facility charge?
A facility charge covers the cost of running the hospital or clinic. These costs include supplies, equipment, exam rooms and non-physician staff. Facility charges vary based on whether patients are a new or existing patient, the type of visit and the resources required to give effective treatment.
Why is there a facility charge for clinic visits?
The State of Arizona licenses Phoenix Children’s Specialty Clinics as hospital-based clinics. Because of this license, our clinics have the same facility charge as a visit to the main campus. This approach is standard for most other hospital-based clinics across the country.
Will my insurance cover the facility charge?
It depends on your specific insurance plan. Some insurance companies cover the entire facility charge. Other insurance companies cover a percentage of the facility charge. It’s best to check first with your insurance company on their coverage of hospital-based clinic facility charges, so you know what to expect.
My Medical Bill
Why did I get multiple bills for a hospital stay?
Phoenix Children’s bills patients for both facility and professional services. We bill this way to comply with regulations set by the Centers for Medicare and Medicaid Services (CMS) and the insurance industry. When you visit Phoenix Children’s or one of our clinics, you may receive one statement but more than one bill:
- The bill you receive from Phoenix Children’s is for using our facility (also known as facility charges).
- The bill you receive from Phoenix Children’s Medical Group is for the physicians, radiologists and other specialists we employ.
- Other clinicians may bill you separately from their own practices (also known as professional fees).
What is a professional fee?
A professional fee is the bill from the doctor(s) who treated you or your child. When your doctor works directly for Phoenix Children's, the bill will come from Phoenix Children’s Medical Group. However, we have many expert doctors who help our patients, but they aren’t employed by Phoenix Children’s. You will receive a bill directly from their practice for their professional fees. Depending on the services provided, you may receive bills from multiple doctors.
Why are some of my hospital bills covered by insurance and some are not?
With health insurance plans, you often have a deductible or out-of-pocket expense you must pay before you receive full coverage. Each insurance plan is different, so please review your benefits carefully. Contact your insurance company if you have questions about coverage or eligible expenses.
Can I get an itemized billing statement?
Yes, you may request an itemized billing statement that details the services Phoenix Children’s or Phoenix Children’s Medical Group provided. To request this itemized billing statement, call 800-549-3743 any time Mon. – Fri.: 8 am to 5 pm MT.
Who should I call if I have questions about a bill or if I think there may be a billing mistake?
If you have questions about your bill, please contact the specific provider at the number listed on the billing statement. You can also contact our Billing Customer Service team.
Hours: Mon. – Fri.: 8 am to 5 pm MT
Local Phone Number: 602-726-8492
Toll-Free Phone Number: 800-549-3743
Can I pay my bill online?
Yes, Phoenix Children’s offers online bill payments through our online bill portal. If you receive a statement from Phoenix Children’s or Phoenix Children’s Medical Group, you’ve already been assigned authentication information to log in and access online bill pay.
In the online bill portal, you can:
- Get answers to your billing questions
- View your account balance and statements
- Make a payment by credit card
- Set up a payment plan (if applicable)
- Set up text or email reminders
Is online bill pay secure?
Yes, we promise to protect your personal information. Your browser and our secure server encrypt confidential information during transmission, ensuring that all information stays private and protected.
We use state-of-the-art secure sockets layer (SSL) 128-bit encryption and are proud to be a VeriSign Secure site. You can select the VeriSign logo to verify our membership and our commitment to your security. Make sure that your browser is SSL-enabled. We recommend using Microsoft Edge. You should always upgrade browser software to the latest version for optimum security.