Understanding Our Billing Process

As our patient, we care about you and want to help you understand our billing process. The best action you can take as a patient to ensure that your billing is accurate and complete is to make sure that we have correct information about you. This information should include:

• Your name/address/telephone number
• The name/address/telephone number of your guarantor (the person responsible for your bill)
• The name/address/telephone number of your employer
• The name of your insurance company, group number, plan number or other identifying numbers, claims filing address and your insurance company’s telephone number

If You Are Covered by Insurance

You will want to determine the extent of your insurance coverage, and if you are in a managed care plan, and whether M. D. Anderson is "in network." If not, you may still be treated here, but your eligibility for insurance coverage may decrease and your personal financial responsibility may increase.

Please notify us immediately if your insurance carrier changes in order to prevent delay in processing your claims with the correct carrier and possibly even the denial of your claim.

We will verify your insurance benefits with your insurance plan. We also will obtain pre-certifications or authorizations if necessary. You are responsible for obtaining a referral from your Primary Care Provider (PCP), if required.

When you arrive for treatment, if you are in a managed care plan, you will be asked to pay your co-pay. Most managed care plans require that a separate co-pay be collected for each physician office or clinic visit.

If you have any open balances, you may also be asked to pay them prior to further treatment.

M. D. Anderson will file your insurance for you for both hospital and physician visits. If you are an inpatient, your hospital insurance claim will be filed following discharge. If you are an outpatient, your outpatient hospital insurance claim will be filed approximately 14 days from your last visit. Outpatient surgery insurance claims are filed weekly. Insurance claims for all physician charges are filed separately, as charges are entered.

Your monthly patient statement will show all amounts due. If you have a patient balance due on one or more accounts and insurance pending on other accounts, your statement will reflect both patient and insurance pending amounts. Your prompt payment of all amounts for which you personally are responsible will help us to continue our mission to eliminate cancer.

If You Are Not Covered by Insurance

If you are not covered by insurance, your Patient Access representative will provide prior to treatment an estimate of the cost of your care. This estimate will include anticipated hospital, clinic, and physician charges, based on the recommended treatment plan. Please be aware that our estimate may vary from actual treatment cost due to a variety of factors. You are responsible for the full cost of your care.

All self-pay patients are asked to sign an agreement to pay for services received. You also will be asked to provide a deposit in advance covering the estimated cost of your treatment. If your estimate has been paid in full in advance, you may be eligible for a discount from the actual charges. For more information, please contact your Patient Access representative.

If your treatment plan changes during the course of your care, you may be asked to agree to a new estimate. You also may be asked to increase your deposit.

Payment Options

If you are a self-pay patient or if you have a financial obligation to M. D. Anderson after your insurance has fulfilled its financial responsibility, you will be expected to pay the balance due. You will receive a monthly Patient Statement showing all open balances.

If you cannot pay your patient balance in full, it may be possible to arrange a Payment Plan. The length and monthly payment amount of Payment Plans are based on the amount due. Your Patient Access representative can provide information about the monthly Payment Plans which are available.

If the cost of your care is beyond your financial means and you are a Texas resident, you may request an Application for Supplemental Financial Assistance from your Patient Access representative. Eligibility for Supplemental Financial Assistance is based on the Federal Poverty Index.

Refunds

Once all charges have been posted to your account, if the amount of your deposit exceeds the actual charges, you may be eligible for a refund. To request a refund, please contact your Patient Access representative. Your patience is appreciated while all charges are compiled and your accounts are researched to determine whether there are any open balances. If so, the remaining deposit will be applied to those balances. If you have no other financial obligation to M. D. Anderson, your refund request will be processed. Please allow sufficient time for processing and mailing of your refund check.

Frequently Asked Questions

What should I do if my insurance changes?

The name of your insurance company or companies is on your monthly statement. If it is incorrect, please immediately inform your Patient Access representative, or call our Business Office Customer Service Line at 713-792-2991 or 1-800-527-2318. Incorrect information may cause us to miss your insurance company’s filing deadline.

Why do I still have a balance if my insurance company pays 100% of Usual and Customary charges?

Some insurance carriers base payment on the average charge for all hospitals in a given area. This practice does not take into consideration the specialized nature of care at M. D. Anderson and may not cover the full cost of the care you receive. You may be responsible for any balance. You are encouraged to discuss your coverage with your insurer prior to treatment.

How will my payment be applied?

Payment in full is applied to hospital/clinic charges and to physician charges as indicated on your statement. If you pay a lesser amount, your payment will be split 60/40 between hospital/clinic and physician charges and will be applied to the oldest open invoice. To ensure timely and accurate payment posting, please include your remittance coupon, which is attached to your statement.

Further Questions?

If you have questions about any phase of the billing process or about your patient statement, please call us at (713) 792-2991 or 1-800-527-2318.