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UW Health SMPH
American Family Children's Hospital
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Billing Frequently Asked Questions

  1. Do I need a referral to see a UW Health provider?
  2. My UW provider has ordered a specific procedure or test. Do I need to receive authorization from my insurance company before I can have this procedure/test done?
  3. My insurance plan requires a co-payment. Will I be required to pay the co-payment when I check-in for my appointment?
  4. I want to receive a service from a UW Health provider, but I know my insurance won't cover it. Is there a way I can find out how much the service will cost?
  5. Does UW Health accept out-of-state Medical Assistance patients?
  6. I am covered under an HMO or PPO. How can I find out if the UW Health provider I want to see is a participating provider under my plan?
  7. I would like to have some or all of the services associated with a visit treated confidentially so that they are not billed to my insurance. Is this possible?
  8. I'm covered under Medicare. Is there anything I should know about my coverage?
  9. I am unable to pay the full amount of my bill at this time. Is it possible to make payment arrangements?
  10. Why did I receive two bills from UW Health?
  11. What do my statements look like?
  12. Will you file claims to my health insurance for my services?
  13. How much is my visit going to cost?
  14. What is a Facility Fee and what does it cover? 
  15. Why is a Facility Fee charged at UWHC clinics but not at UWMF clinics? Aren’t you all part of UW Health?
  16. Will the Facility Fee always be the same amount? 
  17. How is the Hospital telling its patients about Facility Fees? 
  18. How do I know if my insurance company will cover the Facility Fee? 
  19. Why are two services billed during my physical? 
  20. Does this mean I will have to pay for two visits or services for the same date? 
  21. Will my insurance cover the charges for two visits or services?
  22. I would like to know what my benefits will be next year because I have new insurance. 
  23. How do I figure out how much to put into my flex spending account for next year?
Do I need a referral to see a UW Health provider?

Some insurance plans require the patient to obtain a referral from his/her primary care physician prior to seeing a UW Health physician or other provider. It is your responsibility to understand the provisions of your policy and to obtain a referral if one is necessary. If you are unsure about the provisions of your policy with respect to referrals, you should contact your insurance company's customer service department.
 
My UW provider has ordered a specific procedure or test. Do I need to receive authorization from my insurance company before I can have this procedure/test done?

Again, this varies by insurance plan. Please read your policy and/or check with your insurance company's customer service department if you are unsure as to whether prior authorization is necessary. When prior authorization is required, we will coordinate obtaining this authorization with you, as most insurers request specific clinical information from the provider before they will authorize the service.
 
My insurance plan requires a co-payment. Will I be required to pay the co-payment when I check-in for my appointment?

Copayments will be collected when you check-in. Payments can be made via cash, check or credit card.
 
I want to receive a service from a UW Health provider, but I know my insurance won't cover it. Is there a way I can find out how much the service will cost?

Yes. Wisconsin Act 146 requires health care providers to make information available upon request regarding the provider's charges and insurance payments. Price information for UWHC can be found at wipricepoint.org, or you may contact the UW Health Priceline at 608-263-1507 for a personalized estimate.
 
Please note that you will be given a price range, rather than a specific estimate, as the final charges are based on a variety of factors related to the clinical service provided, the diagnoses associated with those services, supplies used, etc. While it is possible to estimate these, it is not possible to precisely define these until after the service has been provided.
 
For comparative information on the quality of care at UW Hospital and Clinics, please see the Wisconsin Collaborative for Healthcare Quality's website at www.wchq.org.
 
Does UW Health accept out-of-state Medical Assistance patients?

No. Most services are available to Medical Assistance patients within their home state. As a result, we do not accept out-of-state Medical Assistance patients if the services are available within their home state.
 
I am covered under an HMO or PPO. How can I find out if the UW Health provider I want to see is a participating provider under my plan?

There are numerous HMO and PPO plans, and provider networks associated with these plans change frequently. Please consult the provider directory given to you by your plan and/or call your insurance company's customer service department to obtain this information.
 
I would like to have some or all of the services associated with a visit treated confidentially so that they are not billed to my insurance. Is this possible?

Yes. We will establish a confidential account for you, upon request. Please note that all confidential accounts are treated as self-pay; you will be required to pay at the time of service for any services provided under a confidential account.
 
I'm covered under Medicare. Is there anything I should know about my coverage?

UW Health Physicians is a participating provider in the Medicare program and accepts assignment on all Medicare charges.
 
As a participating provider, we agree to accept the Medicare allowed amount as full payment for covered services. We will file all supplemental insurance claims. In addition, we handle most insurance payments, paperwork and correspondence.
 
Medicare pays 80 percent of the amounts allowed for covered services. Patients are responsible for the 20 percent copayment and the annual deductible. Patients are also responsible for any routine or preventive care not covered by Medicare. Some supplemental insurance policies may cover these costs.
 
Learn about the Medicare Part D Prescription Drug Plan
 
I am unable to pay the full amount of my bill at this time. Is it possible to make payment arrangements?

Normally, payment of your bill is due within 15 days of the patient balance appearing on a statement. However, our financial advisors will work with you to arrange a payment plan if special circumstances prevent you from making a full, timely payment. Financial advisors are available Monday through Thursday, 8am to 8pm, Friday, 8am to 5pm, Saturday, 8am to 12pm, and can be contacted at 608-829-5254 or toll-free 877-565-8855.
 
Learn more about UW Health's Community Care Program
 
Why did I receive two bills from UW Health?

Some UW Health patients may receive two bills for health care services, depending on where the services were provided.
  • Facility bill: This bill is for the cost of services at a UW Hospital and Clinics facility, such as clinical staff, supplies and equipment.
  • Professional services bill: This bill is for services provided by UW Health professionals, such as physicians, physician assistants and nurse practitioners.
What do my statements look like?
 
Select the images below to see graphic representations of UW Hospital and Clinics and UW Medical Foundation billing statements, including popup text callouts of specific parts of the statements.
 

UW Hospital and Clinics logo

 

View a sample UW Hospital and Clinics billing statement

UW Medical Foundation (UW Health Physicians) logo

 

View a sample UW Medical Foundation billing statement

 
Will you file claims to my health insurance for my services?

UW Health Physicians files insurance claims, but the prompt full payment of the account remains the responsibility of the patient.
 
Though we may accept payment directly from an insurance company, any amount billed but not paid by insurance is the patient's obligation. Health insurance contracts are agreements between the insured and the insurance company. Please pay the remaining balance and contact your insurance company if you believe there is an error with the claim.
 
How much is my visit going to cost?
 
It can be hard to know ahead of time exactly how much you'll be charged for a visit. Charges are based on such things as time spent with the clinician, services ordered, diagnoses associated with those services, and supplies that are used. To help our patients, UW Health offers an estimate service called Price Line. You may call the UWHC Priceline at (608) 263-1507 or the UWMF Priceline at (608) 829-5637 and ask for a price estimate for procedures, tests and any other related fees. While we try to give our patients the most accurate information, the estimate may be higher or lower than the actual charges.
 
What is a Facility Fee and what does it cover? 
 
Facility fees represent all the costs of operating a building for health care delivery except the doctors’ professional fees. They cover the costs of equipment, utilities, maintenance, supplies and medications administered during a clinic visit. They also pay for care by non-physician staff such as nurses, pharmacists, social workers, medical assistants, respiratory therapists, and dieticians.
 
Because hospital-owned (UW Hospital and Clinics) clinics are required to meet strict patient safety standards and more regulatory requirements than physician-owned practices, facility fees also help to offset the cost of meeting these mandated requirements. 
 
Finally, fees also reflect some of the cost of training of physicians, nurses, pharmacists and other health care professionals.
 
Why is a Facility Fee charged at UWHC clinics but not at UWMF clinics? Aren’t you all part of UW Health?
 
When clinics are doctor-owned and operated, they are able to charge patients a single fee that includes all the costs associated with running their practice. When clinics are hospital-owned, there must be two separate bills, one from the medical group for the doctor’s professional fees and the other from the hospital for all other costs. This second bill is referred to as the "facility fee."
 
UWHC Clinics include West and East Clinics, University Station, Research Park, all UW Hospital-based clinics at 600 Highland Ave., Middleton Rehabilitation Clinic (for physician care only, not therapy), and Oakwood Clinic. The Hospital-owned clinics at Princeton Club East and West offer physical therapy only and therefore do not charge facility fees.
 
UW Health clinics that are owned by UW Health physician groups - UW Medical Foundation and the UW Department of Family Medicine - do not charge a facility fee. 
 
Will the Facility Fee always be the same amount? 
 
Facility Fees vary depending on how much time patients spend with their caregiver(s) and how much equipment is involved in their care. Fees can be higher at specialty clinics such as otolaryngology, ophthalmology, where specialized equipment and services can be more costly. 
 
How is the Hospital telling its patients about Facility Fees? 
 
There are signs in all registration areas at clinics where Facility Fees are charged. This information is also contained in a brochure about our billing practices, which is included in a packet given to all new patients. Staff in our billing office is available to answer patient questions, and we are providing registration and other clinic staff with similar information that can be given to patients to help explain these fees. 
 
How do I know if my insurance company will cover the Facility Fee? 
 
Most insurers do cover facility fees, but some do not. Before your visit, take the time to call the customer service number listed on your insurance card to find out if your plan covers facility fees billed by hospital-owned clinics. 
 
Why are two services billed during my physical? 
 
A physical (also called a "preventive medicine visit") is a medical exam geared for the age and gender of the patient. It includes services to prevent or screen for illness, such as immunizations and health assessment. A preventive medicine exam does not include assessment of a new or existing condition. When a new or existing condition is identified and addressed during a preventive medicine visit, industry billing guidelines require that a separate office visit be billed.
 
Does this mean I will have to pay for two visits or services for the same date? 
 
Yes, however, while you are billed for both services, your charges for each are reduced so that the total amount billed is the same. The fee for the physical exam is reduced by the amount of the office visit. However, if the office visit fee is more than the physical fee, the physical is not charged. This pricing method was set up by Medicare. Because Medicare does not normally cover a preventive service visit, this pricing method reduces the out-of-pocket cost of the preventive service visit for Medicare patients. Even though only Medicare requires this pricing method, UW Health Physicians extends this savings to all patients.
 
Will my insurance cover the charges for two visits or services? 
 
We suggest you ask your insurer whether your policy covers these services before you come to your physical. Even if both the office visit and physical are covered by your insurance, you may have out-of-pocket costs for co-pays, coinsurance, or deductibles. Please know that our pricing policy is intended to limit your out-of-pocket expense when both services are provided during the same visit.
 
I would like to know what my benefits will be next year because I have new insurance.
 
Because of variation among insurance plans, you should get this information directly from your health insurance company, which is required to provide this information to you. Check your insurance card for the appropriate number to call. 
 
How do I figure out how much to put into my flex spending account for next year?
 
Usually the best way to determine how much to contribute is to make a list of expected out-of-pocket medical expenses for you and your dependents for the next year and compare it to your benefits for next year. You also have the option of contacting your insurance company for last year’s records or asking all your healthcare providers for a statement(s) of past charges to review against your benefits for the upcoming year. Most flex plans have administrators that can assist with this process.