Here are some frequently asked questions regarding billing and insurance, along with the answers. (Click on any question to view the answer)

BILLING FAQs
Why did I receive multiple hospital bills with the same account number?
Why did I receive separate bills for the hospital and the doctor(s)?
Will you bill my primary and secondary insurance?
Are itemized statements automatically sent to patients?
Do you offer payment arrangements?
Why is this billed as an outpatient service when I spent the night in the hospital?
Why am I receiving a refund check?
Why did my insurance deny the claim?
Can I come in and talk to someone regarding my bill?
Must I register each time I come to the hospital?
I don't have any insurance. Is there any help available?
I come to the hospital often. Is there any way that I can receive one bill?
Why is there an error on my bill?
What is a co-payment?
What is a deductible?
What is co-insurance?
Why did my insurance company only pay part of my bill?
Why do I need to call the insurance company if they do not pay the bill?
If I have an HMO policy, can I be billed if they do not pay?
I belong to a managed care plan. What should I do before coming to the hospital?
I belong to a managed care plan but needed to be seen in the emergency room, what should I do now?  

INSURANCE FAQs
How do I know if my health plan includes Connecticut Children's?
How will Connecticut Children's know in which health plan I participate?
What is the difference between an HMO and a PPO?
What does "in-network" and "out-of-network" mean?
How do I know if my health plan requires a referral or pre-certification for a service?
What should I do if my health plan includes Connecticut Children's as a participating provider, but I receive an explanation of benefits stating I am out-of-network?
What if I have questions on my bill?

BILLING FAQs

Q. Why did I receive multiple hospital bills with the same account number?
A. If you have services that are billed on a monthly (unit) billing cycle, you may receive multiple bills with the same account number; however, they are for different periods of time.

Q. Why did I receive separate bills for the hospital and the doctor(s)?
A. These bills are for professional services provided by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, and other specialists perform these services and are legally required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you received from them.

Q. Will you bill my primary and secondary insurance?
A. You will need to provide us with complete primary insurance information. As a courtesy to our patients, Connecticut Children's submits bills to your insurance company and will do everything possible to advance your claim. However, it may become necessary for you to contact your insurance company or supply additional information to them for claims processing requirements or to expedite payment.

Q. Are itemized statements automatically sent to patients?
A. No. We send summary bills to the patient. To request an itemized statement, call the business office at (860) 696.6020.

Q. Do you offer payment arrangements?
A. Yes, payment arrangements may be made by contacting Customer Service at (860) 696.6020.

Q. Why is this billed as an outpatient service when I spent the night in the hospital?
A. For an account to be billed as an inpatient service, there must be a physician order. The physician who ordered your services determined that your condition did not meet the requirements for an inpatient admission. The physician's written order dictates whether we bill as an inpatient or outpatient.

Q. Why am I receiving a refund check?
A. There was an overpayment to your account. Either you paid too much on the account and/or your insurance paid at a later date and covered some of what you already paid.

Q. Why did my insurance deny the claim?
A. One or more of the following may apply:

The service you received was not covered under your plan
You did not provide the correct insurance information at the time of service
The service you received was from a physician outside your plan's network
You were not covered by your plan at time of service.
Your primary care physician did not process a referral for the services or an authorization was not obtained prior to the services being rendered.

Q. Can I come in and talk to someone regarding my bill?
A. Yes, our Patient Financial Counselors are here to assist you from 8:00 a.m. to 4:00 p.m., Monday - Friday. Our office is located at Connecticut Children's Medical Center, in Area 2D (behind the cashier).

Q. Must I register each time I come to the hospital?
A. Yes, information gathered from patient registration is stored in our computer system. We retrieve this information each time the patient returns for services and we ask the patient to verify that the information is current and accurate. Your assistance in verifying the information is always appreciated. Information may be obtained prior to the service, eliminating a stop at the registration office.

Q. I don't have any insurance. Is there any help available?
A. We have financial counselors who will assist you with applying for different government programs or will give you advice on how to proceed. We can also review your financial status to see if you qualify for hospital Free Bed funds.

Q. I come to the hospital often. Is there any way that I can receive one bill?
A. Unfortunately, because of insurance requirements, we may be required to bill each visit separately.

Q. Why is there an error on my bill?
A. If you have questions about your bill, or believe that it is incorrect, call the Customer Service department at 860.696.6020 or 888.690.2262, Monday-Friday, 8 a.m. – 5 p.m. Confidential voice mail is available after hours, and your call will be returned on the next business day. You can also send us an e-mail message.

Q. What is a co-payment?
A. A co-payment is a set fee the member pays to providers at the time services are rendered. Co-pays are applied to emergency room visits, hospital admissions, office visits, etc. The costs are usually minimal. The patient should be aware of the co-payment amounts prior to the date of service.

Q. What is a deductible?
A. Deductibles are provisions that require the member to accumulate a specific amount of medical bills before benefits are paid. For example, if a member’s policy contains a $500 deductible, the member must accumulate and pay $500 out of pocket before the insurance carrier will pay benefits. Once the patient has met their deductible, the carrier usually pays a percentage of the bill. The patient is liable for the unpaid percentage. Deductibles are yearly, usually starting in January.

Q. What is co-insurance?
A. Co-insurance is a form of cost-sharing. After your deductible has been met, the plan will begin paying a percentage of your bills. The remaining amount, known as co-insurance, is the portion due by the patient.

Q. Why did my insurance company only pay part of my bill?
A. Most insurance plans require you to pay a deductible and/or co-insurance. In addition, you could be responsible for non-covered services. Please contact your insurance company for specific answers to your questions. You may have out-of-pocket expenses.

Q. Why do I need to call the insurance company if they do not pay the bill?
A. If you have a PPO policy, you are ultimately responsible for the total bill or any portion of the bill your insurance carrier does not pay. The Central Billing Office will make every effort to resolve the account balance with your insurance carrier. Occasionally, we will be unable to resolve the issue with your carrier and will need your assistance.

Q. If I have an HMO policy, can I be billed if they do not pay?
A. If you have an HMO policy, you should only be billed for the amount specified on your explanation of benefits (EOB) that is provided to you by your insurance carrier. This usually includes co-pay amounts, deductibles and non-covered services.

Q. I belong to a managed care plan. What should I do before coming to the hospital?
A. Read your insurance plan booklet to be sure you have followed all the guidelines for referrals and authorizations, or call your insurance for assistance. Failure to follow your plan requirements may result in greater out-of-pocket expenses for you. Your primary care physician plays a very important role in this process, if you receive a verbal authorization number, please provide us with this information at registration.

Q. I belong to a managed care plan but needed to be seen in the emergency room, what should I do now?
A. After receiving services, if you did not contact your primary care physician or your insurance plan before you came to the emergency room you will need to contact them within 24 hours explain the circumstances and ask for authorization.

INSURANCE FAQs

Q. How do I know if my health plan includes Connecticut Children's?
A. Connecticut Children's participates in most major health plans in Connecticut. In addition, please review your health plan provider directory and/or consult with your health plan to confirm coverage.

Q. How will Connecticut Children's know in which health plan I participate?
A. Please present your current health plan identification card when you register for inpatient or outpatient services at Connecticut Children's.

Q. What is the difference between an HMO and a PPO?
A. Health Maintenance Organizations (HMOs) require a patient to select a Primary Care Physician to coordinate his or her care. Most HMOs provide care through a network of hospitals, doctors and other medical professionals, that as a patient, you must use to be covered for that service. Preferred Provider Organizations (PPOs) provide care through a network of hospitals, doctors and other medical professionals. When patients utilize health care providers within the network, they receive a higher benefit and pay less money out of their pocket. Services received by a non-participating hospital or doctor may still be covered, but often at a reduced benefit level.

Q. What does "in-network" and "out-of-network" mean?
A. If you receive your health care services from a hospital, physician or other health care provider that participates in your health plan, they are often referred to as "in-network." Hospitals, physicians or other health care providers who do not participate in your health plan may be referred to as "out-of-network."

Q. How do I know if my health plan requires a referral or pre-certification for a service?
A. Your benefit book or provider directory should provide this for you. If not, call the customer service phone number listed on your identification card.

Q. What should I do if my health plan includes Connecticut Children's as a participating provider, but I receive an explanation of benefits stating I am out-of-network?
A. Consult your health plan.

Q. What if I have questions on my bill?
A. If you have questions about your Connecticut Children's bill, or feel that it is incorrect, call 860.696.6020 or 888.690.2262, Monday-Friday, 8 a.m. – 5 p.m. Please have the Patient’s name, account number listed on the bill or the patient’s social security number ready when you call. You can also e-mail your questions to us.