Billing information

A handy Log Sheet (PDF): Use it to document conversations with insurance companies and our billing groups.

Managing your child's health care is challenging. In addition, handling the paperwork to pay for your child's care is sometimes confusing and stressful. This overview is meant to help you better understand the bills you are likely to receive, and what you can do to work within third-party rules and regulations for payment of claims.

Questions to ask your insurance provider before your visit:

1. Is Children's Memorial Hospital "in network" for my insurance?

You may want to know if Children's Memorial Hospital and the physicians who practice here are "in network" for your insurance. "In network" means that 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 will be responsible for a part or total amount of the bill.

2. Do I need a referral from my Primary Care Physician (PCP) for my child to obtain the services he/she needs?

If your insurance is an HMO, please be sure that your Primary Care Physician (PCP) completes a referral for all your child's services. For example, to see a physician, you need a properly completed referral for the office visit. However, if the physician orders additional tests (such as an X-ray, CT scan, MRI, lab tests, physical therapy), you must have referrals from your PCP for these services, too. Please review your insurance contract for information about these additional referrals.

3. Is the physician/specialty service included in the benefits my policy covers?

Some physician and specialty services might not be part of the covered benefits under your insurance policy. If you have questions about your insurance coverage, contact your insurance representative.

Tips for the day of your visit

  • Please be sure that you follow any clinical instructions for the day of your child's visit (such as food or beverage restrictions or clothing appropriate for a test.)
  • Bring:
    1) your insurance card,
    2) the physician referral and/or physician orders and
    3) any payment or co-payment that may be due.
  • Remember that the legal guardian (or an authorization from the legal guardian for consent to treat) must accompany the child for each visit. If you have any questions about this matter, please call the medical department with which you have an appointment.