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Medical billing and insurance processing can be complicated and sometimes confusing, especially during a time of illness or hospitalization. Every bill from NewYork-Presbyterian Morgan Stanley Children's Hospital includes a telephone number in case you have questions about the bill, your child's account, or available financial resources. Please do not hesitate to contact our billing department if you have a question.
Shortly after your child's discharge, you will receive an itemized statement of Hospital charges at your billing address. You may receive several bills for different aspects of a single hospital stay. Bills will fall into one of two categories:
- Hospital-related
- Physician-related
Depending on your insurance coverage, you will either be:
- In-Network
- Out-of-Network
The Hospital accepts a variety of insurance plans. Health insurance coverage varies and some services may not be covered. It is possible to be in-network for Hospital services and out-of-network for some physician services. If you are unsure whether you are in- or out-of-network, please contact your insurance provider. In all cases, you, not your insurer, are responsible for all payments for Hospital and medical services.
Hospital BillsHospital bills can be distinguished from physician bills because they will have the NewYork-Presbyterian logo located in the upper left hand corner.
The bill from the Hospital will include items such as room and board, specialized equipment, medications, and tests.
In-NetworkIf your insurance is in-network, the Hospital will file a claim with your insurance carrier. For certain types of insurance coverage, if there is a balance due after your insurance company has processed your claim, or if you do not have insurance, you will be mailed a statement that shows the balance due after insurance payments.
Out-of-NetworkIf your insurance is out-of-network, the Hospital will send you a bill for the amount not covered by your insurance company. However, it is important you confirm the amount you owe with your insurance company.
QuestionsIf you have any questions related to the charges shown on your statement, if you would like to discuss payment options, or if you believe you are owed a refund, please contact a financial services representative at the Hospital by calling (212) 632-7440.
Account balances are to be paid 21 days from the statement date. If your insurance does not cover all the costs of hospitalization and you are experiencing financial hardship, please contact us toll free at 1 (866) 252-0101 to advise us of your situation and ask about options.
Physician Bills - InpatientPhysician bills will have Columbia Department of Pediatrics indicated in the upper left hand corner. Professional fees for your child's pediatrician, surgeon, and other hospital-based physicians will be billed and mailed separately. Each of these bills must be paid directly to the physician or agency on the bill. For example, you may receive bills from:
- Physician(s) who cared for your child while a patient in the Hospital
- The anesthesiologist if your child had a procedure in the Hospital
- The ambulance company if your child was brought to the Hospital by ambulance
- Physicians who you may not have seen your child but who has reviewed your test results
While physician billing can be confusing, there are a few things you should know and do to make things easier and less surprising at the time of billing.
- If you know there is going to be an inpatient stay, call your insurance provider. Often times, the member needs to call in addition to the hospital; to be safe, we recommend you call. This always ensures all preauthorizations are obtained.
- If you know your child is going to have a procedure, ask whether the physician is in- or out-of-network. You should also ask whether anesthesia is needed and if that physician is in- or out-of-network.
- Once your child has been admitted, physicians treating your child may be in- or out-of-network.
- In some cases, your child's care may include services provided by groups outside of the Hospital. An example of this could be a specific and uncommon blood test that is not performed in our lab. If you are unsure if the service will be provided by an outside group, please ask your physician.
You may be able to request an in-network physician for outpatient care. Please ask when you call to schedule your appointment.
It is very important to always bring your insurance card with you to outpatient visits, even if your child has been an inpatient or you have already provided us with insurance information.
As a general rule, it is best to call the number on the physician bill when you receive it. Sometimes, the bill goes to the patient and the insurance provider at the same time, so the bill may not reflect out-of-pocket expenses. The billing office can confirm the amount that is owed and answer any questions you may have. Please do not hesitate to call.
Checklist for Reviewing Hospital and Physician BillsPlease check to make sure the following information is correctly indicated on your bill:
- Account number
- Reference number
- MRN (Medical Record Number)
- Insurance information
- Name and address
You may notice a surcharge on your bill. This is a "tax" the Hospital is required to charge by New York State. The proceeds are given to the New York State Department of Health.
Financial AidNewYork-Presbyterian Hospital has a long-standing policy to assist patients who receive health care services at our Hospital and are in need of financial aid, regardless of age, gender, race, national origin, socio-economic or immigrant status, sexual orientation or religious affiliation.
The following special insurance programs are offered at either no cost or a low monthly premium to individuals who qualify based on family size and income level. Coverage available will vary from state to state.
- Medicaid: for certain individuals with low incomes and resources
- Child Health Plus: for children under the age of 19, who are not eligible for Medicaid, regardless of immigration status
- Family Health Plus: for adults age 19 to 64 who are legal U.S. residents
- Medicaid Managed Care: for Medicaid-eligible individuals, plans focus on preventive health care. New York Presbyterian Community Health Plan is such a plan, which offers Medicaid as well as Child Health Plus and Family Health Plus.
Generally, patients who are eligible for these programs are expected to apply for them before they are considered for charity care/financial aid. For information about how you can apply for these programs, please call our Inpatient Medicaid Referral Unit at (212) 305-2974.
Charity Care/Financial Aid PolicyThe Hospital has a charity care/financial aid policy to assist qualified patients.
- Residents of New York State may qualify for charity care/financial aid for medically necessary emergency services. Residents of the Hospital's primary service area (the five boroughs of New York City)may qualify for medically necessary non-emergency services.
- Patients with income of less than 400 percent of the Federal poverty level may be eligible for charity care/financial aid and may qualify for nominal payments or discounted rates, depending on family size and household income. Installment payment plans are also available. Eligibility will be determined upon completion of a charity care/financial aid application.
- The policy does not apply to services provided by physicians or other service providers, who bill independently for their services. Any requests for charity care or financial aid regarding such services should be directed to those providers.
Information regarding eligibility for charity care/financial aid and the application process is available from the Admitting Office or by calling the Hospital toll free at (866) 252-0101.
