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Billing and payment information
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The following information is provided to help you understand the Children's Hospital billing and reimbursement policy. Please read this information before your scheduled appointment. It is important you come to your appointment prepared and aware of your personal responsibilities.
We will ask you to verify your insurance coverage at each visit. Please have your insurance card available and let us know about changes including:
- Phone number
At your appointment, you may be asked to pay:
- Co-payments required by your insurance company
- Non-covered services; clinics may require special payment arrangements
- Patients without insurance should plan to pay a deposit
You may pay using check, credit and debit cards. We are not able to accept cash payments.
You will get more than one bill after your clinic appointment. Children's bills for expenses such as clinic staff and supplies. Specialty clinic visits also often include separate charges for procedures and tests done during those appointments. The Medical College of Wisconsin sends out a bill for the doctor or other care provider services. A third bill may come from Pediatric Radiologic Services if your child has X-rays or another radiology service.
For questions about your bill from Children's, call (414) 266-6262 or toll-free (888) 449-4998.
For questions about your bill from the Medical College, call (414) 456-4511 or toll-free (800) 242-1649.
Submitting insurance claims
We will submit your claim and allow your insurance company 30 days to pay us. Your claim may become your responsibility if it has not been paid within 30 days. You will receive monthly statement updates. Read the frequently asked questions.
Please remember, the ultimate financial responsibility for payment lies with the patient, not the insurance company.
Health insurance benefits vary. We encourage you to check with your insurance company or employer before receiving service:
- Some plans require referrals or authorization
- Benefits for office visits might depend on the place of service. Physicians provide services in an outpatient hospital clinic. Your insurance may consider the Children’s Hospital clinic charge as a hospital visit and process it according to your hospital benefits.
Services not be covered by your health insurance plan
There are many different types of health insurance plans. The coverage they provide varies significantly. The services covered and the amount you owe depend on the plan you have. You should confirm your coverage before receiving care, except in an emergency.
There are health services that many insurance companies may not pay or may not pay in full. Examples include but are not limited to:
- Elective services, such as procedures done for cosmetic reasons
- Genetic testing and other very new services
- Dental services, such as replacement retainers
- Hearing aids
- Speech therapy
- Contact lenses
Other reasons your insurance company may not pay for a service include:
- You haven’t met your individual or family deductible for the year yet.
- You have already used your maximum benefits for the year.
- Children’s Hospital of Wisconsin is not in your insurance plan’s network. Some insurance networks do not include Children’s Hospital of Wisconsin.
Determining your cost
We will do our best to determine if your insurance plan will cover the services and to obtain authorization to provide care.
What you owe is determined by your plan benefits such as your copay, coinsurance, deductible and out-of-pocket maximum.
You should read your health plan benefits or contact your insurance company to find out if the services are covered. Your insurance company can explain your potential out-of-pocket cost.
You are required to pay the balance of services not covered by your insurance company. If your insurance company will not pay anything for the services, you must cover the full amount. In some cases, you will need to pay prior to receiving services.
Medicaid recipients should come to appointments with a current Medicaid card and be prepared to pay a copay portion.
If you are worried about paying your medical bills, ask about our financial assistance programs.
For more information, call (414) 266-6262 or toll-free (888) 449-4998, 7:30 a.m. to 4 p.m. Central Time Monday through Friday.