Co-insurance- Percentage of your healthcare bill that is your responsibility. Normally, insurance plans have at least a co-payment or a co-insurance.
Co-payment- Pre-set dollar amount you have to pay before insurance coverage begins. As part of your policy, co-payments are paid for each medical service received. Physician co-pays will not include lab tests, radiology and pharmacy charges. Children's will bill separately for those services. These charges may be applied to your outpatient deductible.
Deductible- Amount an insured patient family has to pay before the insurance company pays benefits. Typically, the deductible is calculated as an annual expense. If your insurance plan has a deductible and 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, payments apply toward your deductible.
Explanation of benefits (EOB)- Itemized charges and distribution of payments. An EOB is sent from the insurance company to both Children’s and the patient/family post service.
Guarantor account- Global, or umbrella, account numbering scheme for all the children in a family. This allows us to pool, monitor, and provide a family’s financial information for all accounts together on a monthly statement.
In-network/out-of-network- Whether the doctors or facilities are covered or 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.
Medical record account- Internal numbering scheme of the medical chart for your child. This number does not change with each visit to Children’s Medical Center.
New account- Generated virtually each time you have services at Children’s Medical Center.
Outpatient facility, day surgery, specialty clinic, and ambulatory- 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" services, based on the child's medical condition. If that is the case, these services will be billed as "outpatient" services instead of as “inpatient” and will be subject to your plan's outpatient deductible requirements.
Payment plans- 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 it. There is a notification on your bill under each account listed that notes how long the account has been due.
Physician bill- The bill you will receive from your treating physician. Physicians are not employed by Children’s Health. The physicians bill for professional fees separately from Children’s. If you receive a bill for professional physician services, please contact the phone number on the bill for assistance.
Plan administrator- Helps you 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- Monthly fee you pay to your insurance company to have coverage. This amount is not necessarily going toward anything, but ensures you are covered. Generally, if the deductible is higher, the premium will be lower.
Tertiary care hospital- A hospital able to receive specific patients and one which 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.
Since we specialize in pediatrics, our charges may be higher than those in your physician’s office or at a community hospital. However, our charges are comparable to those in other pediatric specialty facilities.
Treating physician- Physician who provides, or has provided, medical treatment or an evaluation of your child. When medical treatment or an evaluation is provided, the physician establishes a relationship with you. At this point, the government considers the medical provider as the 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 is in-network. You may also receive a separate physician’s bill from you Children’s bill. If you receive a bill for professional physician services, please contact the phone number on the bill for assistance.