Frequently Asked Questions
Below you will find commonly asked questions regarding billing and insurance. Before calling to ask your question, please review this information to see if an answer is provided.
Questions About Online Bill Payment
What bills can I pay using My IU Health or Guest Pay?
Any IU Health billing statements from the 250 N. Shadeland Avenue, Indianapolis, IN 46219 address can be paid with Guest Pay or My IU Health. If your billing statement’s address is different, your statement is probably from another location or for a service that cannot be paid using Guest Pay or My IU Health.
What information do I need to make an online payment?
Before initiating a new payment, gather the following information:
- Account/invoice number of the bill you want to pay and the address to which the bill was sent.
- Payment account number (of the credit card, debit card, checking or savings account you will use to pay the bill).
- Routing number (of the institution at which you have the payment account, as described below).
How do I find my bank's routing number?
The routing number is a nine-digit number that identifies the institution with which you have the account. To find it, look for the numbers shown at the bottom of your check or on your savings deposit slip.
The balance due on my bill doesn't seem to be right. What should I do?
Contact our Customer Service department for all questions about your account balance.
How long will it take for my payment to be posted to my account?
Please allow 2-3 business days for your payment to be posted to your account.
What if my checking or savings account does not have sufficient funds to cover a payment?
We make withdrawals authorized by you from the checking or savings account that you designate as the payment account.
As with any payment account, you must provide sufficient funds to cover all payments. Since we have no knowledge of your account balance at any time, we cannot notify you if your payment account has insufficient funds.
There will be additional charges for payments attempted against accounts with insufficient funds.
What kind of access do you have to my checking or savings account?
We only have access to your account to make payments that you have authorized. We never access your payment account(s) without your authorization and, as noted above, we do not have information about your account balance.
Is it safe to pay bills online using your service? Can others see my personal information?
We are committed to protecting your personal information. In addition, whenever you are viewing or paying bills, you are using a secure connection that fully protects your information.
Data you provide cannot be viewed by anyone else on the Web, and we do not share your information with anyone else. Security is maintained by industry-standard SSL (secure socket layer) encryption and decryption technology. The SSL protocol is used to ensure that your information is sent directly to us, and that only we can decode it.
While you are using our service, we need to store some information on your computer's hard drive in the form of a cookie. (A cookie is a small file that a website puts on your hard drive so that it can retain information for later use.)
For this reason, the cookie functionality must be enabled in your browser in order to use the digital billing system. However, the cookie will never read information from your hard drive or copy information about other sites that you visit.
Questions About Your Bill
What is a consolidated patient statement (CPS)?
Consolidated patient statements (CPS) are based on the principle of one patient, one guarantor. These statements show the amount owed for both physician and hospital bills.
If all your physician and hospital bills have the same guarantor, you will receive one statement. If you have different guarantors on any of your physician and/or hospital bills, you will receive one statement per guarantor.
How do I read my consolidated patient statement (CPS) bill?
To help with any questions you may have about the CPS bill, we have put together a sample statement (PDF) with explanations and definitions for you.
If you are unable to find the answer to your question on this, please contact our Customer Service department during normal business hours.
Why is my insurance and/or personal information incorrect?
We receive all of your personal and insurance information from the department with whom you first registered.
If there is an error, please provide us with the correct information and we will follow up with the appropriate department to ensure that this does not happen again.
Why did I receive a bill from my doctor in addition to my hospital bill?
These bills are for professional services provided by doctors who assisted in diagnosing and interpreting test results while you were a patient.
Pathologists, radiologists, cardiologists, anesthesiologists, and other specialists perform these services and are legally obligated to submit separate bills.
If you have questions about these bills, please call the phone number printed on the statement you received from them.
What is an Explanation of Benefits (EOB)?
An EOB, or Explanation of Benefits, is a statement sent that provides necessary information about claim payment and patient responsibility amounts.
Some of the information you may see on an EOB includes:
- Provider of care
- What services were covered
- What amounts were paid
- What discounts/adjustments the provider is contractually obligated to write off
- Which, if any, services were denied by your coverage and why
- Your deductible and/or co-insurance and/or co-payment amounts
- Sometimes an EOB is also called on EOP, or Explanation of Payment.
I received an EOB from my insurance company. Is this a bill I need to pay?
No. An EOB is simply an explanation of your insurance benefits.
If your EOB shows a deductible, co-insurance and/or co-payment amount on it, you will receive a bill from IU Health once we’ve received and posted your insurance company’s payment.
Why do I have two bills and two co-pays for services that have always been one bill and one co-pay in the past? Why am I getting a bill for a co-pay when I paid my co-pay at my doctor’s office?
Your physician has changed from physician-based billing to provider-based billing. Provider-based billing, also known as hospital-based outpatient billing, refers to the billing process for services rendered in a hospital outpatient clinic.
Previously, your physician was doing the billing for all of the components of your visit, which included the physician’s services, the building, nurses, supplies, equipment, utilities, legal, and accounting.
Now, by implementing provider-based billing, the physician is only billing for the physician services. The hospital now bills for all other components of your visit.
IU Health and our partnering physicians chose to do provider-based billing because it ensures more appropriate payments.
Also, provider-based billing is the national model of practice for large, integrated delivery systems involved in patient care and is approved by Medicare.
By choosing an IU Health physician, you have elected to be treated by a provider that can offer all of the amenities that come with a large, integrated delivery system.
Can I come in to talk to someone regarding my bill?
Yes, our Patient Financial Service Representatives are here to assist you from 8 am – 4 pm EST, Monday – Friday, excluding all major holidays. You can find our office at 250 N. Shadeland Avenue, Indianapolis, IN 46219.
Can I pay an outstanding invoice at my doctor's office?
Yes. The payment will post to the oldest date of service with an outstanding balance.
Do you offer payment arrangements?
On Feb. 1, 2011, IU Health implemented a new Consolidated Patient Statement (CPS) which allows us have one bill per patient per guarantor.
Both physician and hospital bills will be on the same statement. Part of this implementation included adding a new "Minimum Due" payment option. This option allows you to pay a pre-calculated minimum amount each month without any additional costs to you and without having to contact our Customer Service department.
Why am I receiving a refund check?
We received an overpayment on your invoice. Either you have paid too much on your invoice and/or your insurance paid at a later date and covered some of what you had already paid.
If you feel that you have received this refund in error, please contact our Customer Service department during normal business hours.
My insurance paid more than billed charges. Why do I owe anything?
Some insurances pay using the DRG (Diagnosis-Related Group). A DRG payment is one payment by your insurance company for your entire stay. This payment is based on your diagnosis rather than on each individual charge, regardless of the length of stay or what the total charges were. It doesn't matter if the patient stay was 5 days or 30 days, or if the charges were $50,000 or $500,000. The hospital will get paid exactly the same amount.
Under your coverage plan, you are still responsible for a co-pay when your insurance pays based on DRG.
Please contact your insurance company or review your benefits booklet for more information on your insurance coverage if your personal liability is larger than you expected.
Additional Information: When Medicare was established in 1966, the regulations specified that Medicare would not pay charges, but would pay hospitals the cost of services provided. Charges became less important, and attention was focused on the best way to incur and report costs. Insurers and patients still paid charges however, so that in order to make any return on investment (profit) hospitals increased charges above cost. With the advent of Managed Care in the 1980s, insurers also obtained discounts from charges. Medicare changed to the Diagnosis Related Group (DRG) methodology in 1982. This system pays hospitals an amount based on the diagnosis of the patient.
I don't have any insurance. Is there any help available?
We can assist you in several ways. If you do not qualify for any type of government programs, we can review your financial status to see if you qualify for our Financial Assistance Program.
We also provide a financial adjustment to any uninsured patient who obtains medically-necessary or emergency services from IU Health.
What should I expect to pay?
IU Health offers tools to estimate your out-of-pocket cost for services to be received at one of our locations.
Estimates are based on the typical care experience for patients receiving that service. Your provider’s treatment choices and your particular health care needs might mean your specific care and out-of-pocket costs differ from this estimate. The estimate you receive includes related services. Related services might be hospital or facilities fees, services of IU Health-employed physicians, lab, radiology, or drugs commonly provided with the service(s) you select.
What are my rights and protections against surprise medical bills?
When you get emergency care or are treated by an out-of-network provider at
an in-network hospital or ambulatory surgical center, you are protected from
balance billing. In these cases, you shouldn’t be charged more than your plan’s
copayments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other healthcare provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of services at these facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
Visit cms.gov/nosurprises/consumers for more information about your rights under federal law.
Questions About Insurance
I belong to a managed care plan. What should I do before going to the doctor?
Read your insurance plan booklet to be sure you have followed all the guidelines for referrals and authorizations, or call your insurance company for assistance.
Failure to follow your plan requirements may result in greater out-of-pocket expenses for you. Your primary care physician (PCP) plays a very important role in this process.
If your PCP gives you a verbal authorization number, please provide us with this information at registration.
Will you bill my primary and secondary insurance?
You will need to provide us with complete primary and secondary insurance information. As a courtesy to our patients, IU Health 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.
Why did my insurance company deny the claim?
There are several reasons why your insurance company may deny your claim. 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 of your plan’s network
- You were not covered by the plan at the time of service
- The EOB sent to you by your insurance company should explain in more detail why they denied either a portion of the claim or the entire claim. If you receive a denial from your insurance carrier and still have questions, you should contact them to better understand the reason for the denial.
How do I know if my health plan includes IU Health?
IU Health participates in most major health plans in Indiana. Please review your health plan provider directory and/or consult with your insurance company to confirm coverage.
How will IU Health know what insurance I have?
When you register for services at IU Health, please present your current health plan identification card.
What is the difference between an HMO and a PPO?
Health Maintenance Organizations (HMOs) require you to select a Primary Care Physician to coordinate your care. Most HMOs provide care through a network of hospitals, doctors, and other medical professionals that you must use in order to be covered for services provided.
Preferred Provider Organizations (PPOs) provide care through a network of hospitals, doctors, and other medical professionals. When you use healthcare providers within the network, you pay less money out of your pocket. Services received from a non-participating hospital or doctor may still be covered, but often with greater out-of-pocket expense for you.
What do "in-network" and "out-of-network" mean?
If you receive your healthcare services from a hospital, physician, or other healthcare provider that participates in your health plan, they are often referred to as "in-network."
Hospitals, physicians, or other healthcare providers who do not participate in your health plan may be referred to as "out-of-network."
How do I know if my health plan requires a referral or pre-certification for a service?
Your benefit book or provider directory should have this information. If not, call the customer service phone number listed on your identification card.
I belong to a managed care plan but needed to be seen in the emergency room. What should I do now?
If you did not contact your primary care physician or your insurance company before you came to the emergency room, you will need to contact them within 24 hours of receiving services to explain the circumstances and ask for authorization.
What should I do if my insurance includes IU Health as a participating provider but I receive an EOB stating I am out-of-network?
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 the plan at the time of service.
If your EOB states that the services you received were out-of-network, consult your insurance company. If you have further questions about your account, you may also contact Patient Financial Services.