Common Questions about Billing, Insurance and Estimates

We provide estimates of out-of-pocket costs in three ways:

1. If you've scheduled a visit or procedure, we will give you an estimate in your My Health at Vanderbilt online account or by phone.
2. If you are a patient, you can create estimates of out-of-pocket costs through your My Health at Vanderbilt account. You can get estimates for many services and we are adding more services over time. This estimate will take into account your insurance coverage and any co-pays, co-insurance or deductibles you may owe. (Care you have received or paid for very recently may not be factored into the estimate). Visit My Health at Vanderbilt to create your estimate.
3. If you are not a patient at Vanderbilt, you can create a "guest estimate" online. You will need to enter your insurance information. The accuracy of the estimate will depend on the accuracy of the information you enter.

Many things influence prices and estimates. One of the most important is whether the estimate includes everything involved in that service.

For example, estimates for many of Vanderbilt Health's hospitals and clinics include the services of doctors involved in your care.

Some hospitals may quote a price that excludes fees for doctors' services (called professional services). This is common when hospitals do not employ the doctors who deliver care. The surgeons may be independent but have privileges to do operations at that hospital. The anesthesiologists, radiologists, pathologists and ICU doctors may be contracted.

In those cases, the up-front estimate could be lower than what you actually owe. This is the case for Vanderbilt Health's community hospitals (Vanderbilt Wilson County Hospital). You may get a bill from us as well as from the doctors involved in your care.

Pricing may also be different at hospitals that provide more complex care and do research. However, you may also have access to doctors with greater expertise and to more advanced treatment options and technology.

Your insurance coverage may also differ from hospital to hospital.

Please tell us if you cannot pay your bill in full — we can help.

We will discuss our financial assistance policy and payment plan options. We'll also help you find community and government resources. Financial hardship is decided on a case-by-case basis. Learn more and contact us.

A common reason for this is having inaccurate or incomplete insurance information in our system. Other reasons include a change in your coverage or denial of coverage.

Make sure we have your current and accurate insurance information. Verify this information during check-in for any appointment or procedure. Or you can verify information at any time in My Health at Vanderbilt. Find the insurance summary section under "billing." You'll see the details we have on file and can request a change.

Yes. Our team in Patient Financial Services can help you. Call us at (615) 936-0910.

By policy, we collect the amount you are responsible for paying before or at the time of service. You can discuss payment options when you arrive for your visit or by phone before your visit.

Confirmed over-payments will be refunded within 60 business days. If you have questions about your refund or wish to have it refunded more quickly, call (615) 936-0910. We may also apply over-payments to outstanding balances.

One of the benefits of receiving care at an academic medical center like Vanderbilt is access to the most promising new approaches being studied in what are called "clinical trials." Typically, the costs that are directly part of the study, including the drug or device, are coved by the study. Other care that is considered routine -- that is, care you would receive even if you weren't part of the study -- is not covered by the study.

Ask your insurance company about coverage of care that you receive while taking part in a clinical trial. Your study coordinator can also help you get these answers.

Your insurance coverage has the greatest effect on what you will pay for care at Vanderbilt.

Following are some questions you can ask your insurance provider to help you understand the out-of-pocket costs for which you are responsible.

• What type of insurance plan do I have?
• Is Vanderbilt Health in my provider network?

If Vanderbilt Health is in network, here are some follow-up questions:

• D​oes my insurance plan cover physician costs, as well as inpatient and outpatient hospital services? These are sometimes called professional fees and facility fees.
• Does my insurance plan cover prescription medications and chemotherapy medications?
• What percentage of my bill does my insurance cover?
• What, if any, are my co-payments and/or deductible amounts?

If Vanderbilt Health is not "in network," here are some follow-up questions:

• Does my plan offer access to Vanderbilt Health through a national rental network?
• Does my plan have out-of-network benefits? If yes,  and I choose to go out-of-network, what percentage of my bill will be paid by the insurance company?
• Does my insurance plan offer any additional coverage through special networks for treating medical conditions such as cancer?

Other questions to ask:

• Does my plan have an out-of-pocket maximum? If yes, and I reach the maximum, will my claims then be paid in full?
• Before I see a doctor at Vanderbilt, do I need a referral from my primary care physician? Will I need an authorization from my insurance carrier?
• Do I need any prior authorization for elective services?
• Will I be covered for any testing, pathology, or radiology charges that may be incurred as part of my initial consultation with a Vanderbilt doctor?
• If I take part in a clinical trial, does my plan cover routine medical care that I receive while on a study?