Understanding Your Out-of-Pocket Estimate
At UnityPoint Health, we are committed to providing patients with information about their out-of-pocket costs as they make health care decisions. Providing estimates and connecting you with payment options are just two of the ways we're working to be your partner in health. Below are some frequently asked questions and answers to help understand your out-of-pocket estimate.
Why am I receiving an estimate letter?
Many patients are now being asked to pay more than they may have in the past. Providing an estimate helps our patients make informed health care decisions and better manage their healthcare dollars. The estimate also provides information about additional support to help patients better understand their financial options.
How are my out-of-pocket expenses calculated?
Patients are responsible to pay the full costs of services not covered by insurance, which are called out-of-pocket costs. To calculate your estimated out-of-pocket responsibility, our team reviews your insurance coverage and benefits including co-pay, coinsurance, deductible and maximum out-of-pocket responsibility (see definitions for those terms below). The out-of-pocket estimate can include any combination of these costs.
- Co-pay: A co-pay is a set amount you pay for a service. Co-pays can vary by service type and are most common for office visits and emergency room visits.
- Deductible: A deductible is the amount you pay annually for services before health insurance will begin to pay. Sometimes, you may be 100% responsible for the cost of a service until your deductible is met.
- Coinsurance: Coinsurance is the percentage you pay of any future healthcare costs after the deductible has been met.
- Maximum Out-of-Pocket: The maximum out-of-pocket amount is the most your insurance expects you to pay for all covered services in the plan year. Once that amount is met, your insurance should begin to pay 100% of the allowed amount for any covered services.
Do I have to pay the full estimated amount prior to the date of service?
We ask for a partial prepayment before the date of service. You can do this by calling our team at 1 (877) 853-6230 (toll free) on Monday - Friday between 8:00 a.m. - 4:30 p.m. During that call, we can also help answer any financial planning questions you may have and set up additional financial support if needed.
Does the estimate include all charges and fees?
Estimates are for hospital fees and usually do not include physician, anesthesiologist or other professional fees. Any items determined to not be covered by your insurance plan may become the patient's responsibility and will be included on a bill after the service is provided.
How accurate is the estimate?
We use past cost information to provide an accurate estimate, but actual amounts may increase or decrease depending on what care is needed according to your provider. Your remaining deductible or maximum out-of-pocket costs may also change depending on other services you may be receiving.
What if I make an overpayment?
If the actual amount you owe is less than your prepayment, we apply any credits to other outstanding balances you may have with UnityPoint Health. If you have no outstanding balances, a refund will be sent to you.
How may I pay?
We accept payments over the phone by calling 1 (877) 853-6230 (toll free) Monday – Friday between 8:00 a.m. – 4:30 p.m. After your services, you will receive a full billing statement. You can make payments online or through MyUnityPoint patient portal at chart.myunitypoint.org. We accept cash, check, or credit card (Visa, MasterCard, American Express, Discover or Health Savings Account plans) before or after your service. Flex Spending Account (FSA) cards can be used on the day of service.
What if I do not have access to the MyUnityPoint patient portal?
You can sign up for a MyUnityPoint account online to enroll.
Who may I go to if I have additional financial questions?
You can call 1 (877) 853-6230 (toll free) Monday - Friday between 8:00 a.m. - 4:30 p.m. to speak to our financial experts.