Common Price Estimator Questions
Definitions of Terms
- Total Charges: The hospital’s total gross charge for the service selected.
- Your Insurance Allowable Amount: The dollar amount that is typically considered payment-in-full by your insurance company. This includes both payments made by your insurance company as well as the amount your insurance company states that you, the patient, are responsible for.
- Your Insurance Co-Pay Amount: A copayment or copay is a fixed amount paid by the patient before receiving a covered service. It may be defined in an insurance policy and is paid by the patient each time they receive the service.
- Your Co-Insurance Amount: The percentage of the amount covered that your insurance requires you to pay based on your individual benefit plan.
- Your Insurance Deductible Amount: The annual amount you have to pay each year before your benefit plans starts paying benefits based on your insurance plan selection.
- Your Estimate Hospital Cost for Care: The estimated amount/cost for hospital services you will be responsible for paying (may differ if services rendered change).
Common Pricing Questions
- What is the UH Hospital Price Estimate tool?
The UH Hospital Price Estimate tool is a self-service web-based tool available to improve consumer access, communication and experience while aligning to price transparency and supporting decision making in advance of service.
- How is the estimate amount determined?
At University Hospitals, all individuals are treated with respect, regardless of their individual financial circumstances.
If you are an uninsured patient, your estimate will reflect the hospital’s total gross charges for the service you requested. If you meet established financial eligibility requirements, your bill for medical care at a UH hospital facility may be discounted under the UH Financial Assistance Program. Call a financial counselor at 1-866-771-7266 for available payment options.
If you are an insured patient, the service requested is compared to your insurance benefits as of the date of the estimate. The estimate tool calculates your insurance allowable, co-pay, co-insurance and deductible amounts based on your individual plan benefits provided by your insurer.
- What information is required to run an insurance-based estimate?
The UH Hospital Price Estimate tool requires a minimal amount of information to validate your current co-pay and deductible amounts on your policy. Insurance company, subscriber or member ID, your name exactly as it appears on your insurance card, and date of birth are all required. Without this information, the estimate tool would not be able to accurately provide a true estimate of expected cost as it relates to your individual policy.
- Will UH use my information for any other reason if I run an estimate with my insurance information?
No, your information is solely used for the purpose of checking your benefit information to guarantee you the closest estimate. UH will not use your information to contact you for any reason.
- How do I know if the estimate is correct?
The projected cost estimate is a good-faith estimate based on the information provided at the time of your request. The actual services ordered by your provider may differ from the procedure you selected. The insurance information you enter serves as the basis for your estimate. The estimate will be correct provided the correct service was selected and the benefit information from you insurance company was up-to-date at the time of the request.
- Will my insurance plan cover the service?
Before having the service, please contact your insurance company to confirm coverage under your plan and that University Hospitals is a participating provider. UH participates in most major insurances and benefit plans. After you have the services, your insurance company will review your claim to determine if your benefit plan covers the service. Depending on your plan policies, services not covered under your plan may be billed to you.
- What if I change insurance or my insurance doesn’t cover this care?
This estimate is only valid for the insurance you provide. If you change insurance companies or policy, you will need to enter the updated information in the tool or contact us for a new estimate. Estimates vary based on the insurance plan coverage. If you are not covered by insurance or become uninsured, you may qualify for insurance under the Affordable Care Act or a University Hospitals patient financial advocate can help you in finding assistance based on need.
- Will this estimate show the final amount for the service?
The actual final amounts for the service may change based upon: any changes or additional services rendered as part of your care at the time of the service; treatment or services that your doctor determines you require during the visit; and other information provided by your insurer. This estimate is for your hospital only, out-of-pocket costs and does not include physician charges which may also be incurred.
- How would I obtain both a hospital and physician based estimate?
Contact Financial Counseling by phone Monday – Friday at 1-866-771-7266, 8 a.m. – 4:30 p.m. Front desk, financial counseling and customer service representatives are also able to provide this information upon request.
- What about my privacy?
This estimate may contain private information that is legally protected. It’s only for you to use. If you are not the patient, you need to know that sharing, copying or acting on the information is against the law.
- Where can I find my subscriber/member ID on my insurance card?
The subscriber/member ID is listed on your insurance card. It may also be referred to as an identification number, plan ID, insurance policy ID or Medicare number. Below are several insurance card examples.