Terms to Know
Account - A new account is generated virtually each time you have services at Children’s Medical Center.
- Guarantor account is the global or umbrella account numbering scheme for all the children in a family. This allows us to pool, monitor, and provide our families’ financial information for all accounts together on a monthly statement.
- Medical Record account is the internal numbering scheme of the medical chart for your child. This number does not change with each visit to Children’s Medical Center.
Co-Payment is the pre-set dollar amount you have to pay before your insurance kicks in. If a part of your policy, co-payments are paid for each medical service received. Physician co-pay will not include lab tests, radiology and pharmacy. Children's will bill separately for those services. These charges may be applied to your outpatient deductible.
Co-Insurance is a certain percentage of your healthcare bill you are responsible for. Normally, insurance plans have at least a co-payment or a co-insurance.
Deductible is the amount an insured patient family has to pay before the insurance company pays benefits.Typically, the deductible is a yearly expense. If your insurance plan has a deductible and a co-pay, you will only have to pay the co-payment for regular doctor office visits. For medical expenses outside of regular doctor’s office visits, you will have to pay towards your deductible.
Explanation of Benefits (EOB) itemizes charges and distribution of payments. An EOB is sent from the insurance company to both Children’s and the patient/family post service.
In-Network / Out-of-Network refers to the doctors or facilities covered / not covered by your insurance plan. Physicians negotiate their own insurance contracts. Some physicians could be out-of-network for your insurance even though Children’s Medical Center is in-network.
Most independent physicians will provide families with the in network adjustment on their bill. Please contact that physician billing office for a possible in network adjustment.
Outpatient Facility, Day Surgery, Specialty Clinics, Ambulatory, and Pavilion are all words referring to visits that do not require an overnight stay. Compared to a regular doctor’s office visit, visits to our Outpatient Facility are generally considered a specialty type visit by insurance carriers. Insurance carriers usually have a more expensive co-payment for this type of service. The doctors who treat children in the hospital are highly trained to be the best equipped to handle complex care.
If your child is admitted to an inpatient bed for a short stay, the physician may order "observation" services instead of "inpatient" based on the child's medical condition. If that is the case, these services will be billed as "outpatient" services instead of inpatient and will be subject to your plan's outpatient deductible requirements.
Payment Plans are available for anyone needing to discuss payment options outside of the standard due dates. When a bill is your responsibility, you have 90 days to pay your bill. There is a notification on your bill under each account listed that notes how long the account has been due.
Physician Bill is the bill you will receive from your treating physician. Physicians are not employed by Children’s Medical Center. The physicians bill for professional fees separately from Children’s Medical Center. If you receive a bill for professional physician services, please contact the phone number on the bill for assistance.
Plan Administrator can help navigate the world of payments and answer additional questions. A Patient Financial Services office is located in both the Ambulatory Pavilion and the main hospital.
Premium is the monthly fee you pay to your insurance company to have coverage. This amount is not necessarily going toward anything, but ensures you are covered. Usually, the higher the deductible, the lower the premium.
Tertiary Care Hospital is a hospital able to receive specific patients and has a trained staff in a specialized area. Children’s is the only academic healthcare facility in North Texas dedicated exclusively to the comprehensive care of children from birth to age 18.
Specializing in pediatrics, our charges may be higher than those in your physician’s office or a in a community hospital. However, our charges are similar to those in other pediatric specialty facilities.
Treating Physician is a physician who provides, or has provided, medical treatment or an evaluation of your child.When medical treatment or an evaluation is provided, the physician is considered in a relationship with you. At this point, the government will consider the medical provider as a treating physician.
This is important because Children’s is a separate legal entity from the treating physician. Some physicians could be out-of-network for your insurance even though Children’s Medical Center is in-network. You may also receive a separate physician bill from you Children’s Medical Center bill. If you receive a bill for professional physician services, please contact the phone number on the bill for assistance.