Billing and insurance FAQs
Why do I get multiple bills?
You may receive more than one bill for a single visit. Some of these bills may be from your doctor, and others may be from the hospital. For example, if your child has an X-ray:
- The hospital sends a bill for use of the equipment and clinical staff time;
- A radiologist sends a bill for interpretting the X-ray; and
- Your doctor may send a bill for developing a treatment plan based on that X-ray.
Both the hospital and doctors submit bills to your insurance company.
Is Children's Memorial "in network" for our insurance?
"In network" means your insurance company has a contract with the hospital and our physicians, and usually you have smaller out-of-pocket expenses. You may choose to see an "out of network" provider, but this typically means you must pay a part or all of the bills. We encourage families to contact their insurance company directly for more information.
Do we need referrals?
Many times, yes, especially if your insurance is an HMO. For example, to see a pediatric specialist, you need a properly completed referral for the office visit from your primary care physician. However, if the physician orders additional tests (such as an X-ray, CT scan, MRI, lab tests, physical therapy), your must have referrals for these services, too. We encourage families to contact their insurance company directly for more information.
Is the doctor and service included in the benefits my policy covers?
We do our best to understand the rules of all managed care plans, and are often able to let families know what services are covered by insurance before their visit. However, since some pediatric specialists and specialty services may not be part of your benefits, we encourage families to contact their insurance company directly to find out. If services are not covered by insurance, the hospital asks for payment on the day of the visit.
We have an HMO, PPO, POS or an indemnity insurance plan. What should we expect?
Please bring your current insurance card when you come for your visit. If your insurance is a HMO, PPO, POS or indemnity plan that requires a co-payment, families are asked to pay this amount at check-in. If the amount owed is not listed on your card, we encourage families to contact their insurance company before their visit to determine the correct amount.
We have Medicaid or All Kids. What should we expect?
Please bring your current enrollment card provided by Medicaid or All Kids. The card shows the type of coverage you have and may also include the co-payment amount. If the amount owed is not listed on your card, we encourage families to contact All Kids before their visit to determine the correct amount. Co-payments are collected at check-in.