Financial Matters

Frequently Asked Questions

• Does my plan require a referral or authorization?
• Who is responsible for getting the authorization for my child’s service?
• Does CHOP participate with my health plan?
• How much is my deductible and co-insurance?
• What will the charge be for my child’s visit to CHOP?
• Am I responsible to pay my co-pay or co-insurance at the time of visit?
• Why am I getting several bills if I just went to a specialist office visit?
• I thought my services were covered completely by my insurance plan. Why did I get a bill?
• I haven’t received a bill. Who should I call?
• What other financial assistance is available?
• Why hasn't my insurance paid my claim?
• What do I do if my insurance changes?
• Who qualifies for Charity Care?
• Who will help me during the financial assistance application process?
• What paperwork must I have to determine if I qualify for Charity Care?
• How do I learn if my family qualifies for Charity Care?
• How long does the Charity Care application process take?
• Are there any rules or exceptions to what is covered under Charity Care?
• Must I receive services at CHOP to receive assistance applying for public medical insurance?

Does my plan require a referral or authorization?

Please call your insurance company for more specific plan-related questions. Counselors who staff our Pre-Visit Financial Counseling Hotline are available to assist you with your questions. Please call 1-800-664-7855 or 215-590-3954. 

Who is responsible for getting the authorization for my child’s service?

Parents/caregivers must make sure that authorizations or referrals are taken care of before their children receive services at The Children’s Hospital of Philadelphia. You may be able to schedule services before receiving notice of authorization. Your visit may be canceled or rescheduled if authorization is not approved by your insurance company. If your insurance company needs a referral and/or prior authorization, please call your primary care doctor before scheduling an appointment with us.

Does CHOP participate with my health plan?

Review the list of payors (insurance companies) with which we participate. If your plan doesn't appear on this list, call your insurance company to ask if they consider CHOP to be "in-network." You may also call our Pre-Visit Financial Counseling Hotline at 1-800-664-7855 or 215-590-3954.

How much is my deductible and co-insurance?

Most insurance plans make you pay for your part of the service provided to your child through a “co-pay,” “deductible” and/or “co-insurance.” All of these amounts are set by your insurance plan. Please call your insurance company directly for more information.

What will the charge be for my child’s visit to CHOP?

For questions about what the charges may be for your child’s visit to CHOP, please:

• Call your insurance company if you have questions about specific procedures or tests that you know will be performed, and know those procedures’ CPT codes. A CPT code is a number assigned to every task and service a medical practitioner may provide to a patient including medical, surgical and diagnostic services. With this information, your insurance company may be able to tell you what your financial responsibility will be.
• Call our Pre-Visit Financial Counseling Hotline at 1-800-664-7855 if you are bringing your child in for outpatient visits. Ask what the fee for the physician office visit may be. The actual cost of care varies from one patient to another. Our medical care is individualized to best meet the needs of your child. We cannot always determine in advance what services you will require and receive, so we may not be able to provide a complete estimate of cost in advance. When you come for an outpatient visit, you will be charged for the physician’s visit and for any procedure or test performed during the visit. Most visits result in both a Physician bill and a Hospital bill.
• If you are bringing your child in for an inpatient visit, you will be charged for: 
  • The physicians’ time spent examining your child
  • Any procedures/tests that are performed
  • Hospital services including nursing care, supplies, machines, equipment and the use of the Hospital’s facilities.

Again, the actual cost of care varies from one patient to another because all of our medical care is individualized to best meet the patient's needs.

Am I responsible to pay my co-pay or co-insurance at the time of visit?

Yes. CHOP accepts payment in the form of cash, credit cards and checks. If our staff is unable to collect your physician and/or hospital co-pay at the time of your visit, you will be billed separately for the applicable co-pay(s). Not all charges may be known at the completion of your visit or discharge. As the clinical team completes the necessary information regarding the services rendered, the billing statements will be adjusted accordingly. For example, sometimes a clinical lab needs to be sent out to a specialty lab for additional processing. This additional processing will result in additional services provided, and the bill will be updated appropriately.

Why am I getting several bills if I just went to a specialist office visit?

There are two bills you may receive: a Hospital bill for services provided at CHOP and a Physician bill for all of your physician charges. Your bill includes all of the charges for each of your children who receive care at CHOP. Review samples of both bills »

I thought my services were covered completely by my insurance plan. Why did I get a bill?

Even if your insurance plan covers your visit to CHOP, you are still responsible for any cost-sharing expense, such as co-pays, co-insurance and deductibles. The amount will vary depending on your insurance. Get help understanding co-pays and your health insurance »

I haven’t received a bill. Who should I call?

If you have received an explanation of benefits (EOB) from your insurance carrier but have not received your Hospital bill and Physician bill within 90 days of receiving the EOB, please contact us at 800-283-3055.

What other financial assistance is available?

Public health insurance and other state or federally funded programs are available to those who qualify. In addition to applying for Charity Care, families can receive help applying for public health insurance and other forms of assistance through the Department of Family Health Coverage Programs. Call CHOP's Family Health Coverage Program at 1-800-974-2125.

Why hasn't my insurance paid my claim?

It can take up to 45 days for health plans to process claims. If the health plan requests additional information such as medical records, it can then take up to 60-90 days for them to process our claim. 

What do I do if my insurance changes?

Please call the Hospital's Business Office customer service number at 800-283-3055 to provide any updates to your insurance coverage. Please have your current insurance card with you at all times.

Who qualifies for Charity Care?

When considering a family for Charity Care, we ask about income level, available assets and other financial responsibilities of a patient/family. Even if you have health insurance, you may still qualify for Charity Care to pay for healthcare bills that are not covered by your insurance.

Who will help me during the financial assistance application process?

The Department of Family Health Coverage Programs will assign a coordinator to help you apply for available public and private assistance programs and if applicable, Children's Hospital Charity Care.

What paperwork must I have to determine if I qualify for Charity Care?

You must complete the Charity Care application and supply other required documents. The Family Health Coverage coordinator will give you a list of required documentation, answer your questions and monitor your application process.

How do I learn if my family qualifies for Charity Care?

You will receive a letter in the mail. Your Family Health Coverage coordinator will be available to help you review your letter and answer any questions you might have.

How long does the Charity Care application process take?

Although the entire process may take several weeks, you can be considered for Charity Care as soon as you complete the application, which usually takes less than an hour. Be sure to contact the Department of Family Health Coverage Programs as soon as possible. Final decisions will not be made until the entire application is completed.

Are there any rules or exceptions to what is covered under Charity Care?

Prescriptions: It is important to note that although prescriptions are covered, they must be prescribed by a CHOP physician and filled at the CHOP pharmacy.

Research: Anyone who is participating in a grant study that provides healthcare coverage must use that coverage. Charity Care will not cover an expense that is eligible to be covered through research.

For more information or to confirm that your services are covered, please consult your Family Health Coverage coordinator.

Must I receive services at The Children's Hospital of Philadelphia to receive assistance applying for public medical insurance?

No. CHOP is committed to assisting children and families. As a service to community members, the Department of Family Health Coverage Programs will assist any child or adult who needs help applying for public health insurance. Please call the office so a Family Health Coverage coordinator can help you apply.

Can't find what you're looking for?

Our Pre-Visit Office and Financial Counseling Hotline can help address your insurance and billing questions prior to your outpatient visit.

Call 1-800-664-7855 or 215-590-3954 to reach a financial counselor.