A Guide to Billing

Before your appointment, you can take steps to avoid surprises:

• Review our list of health plans accepted by Vanderbilt Health.
• When making your appointment, be prepared to provide your insurance information.
• Ask about the services you will receive so you can confirm with your insurance company whether they are covered. Check with your health plan to understand these questions.
• Create or review an estimate of your out-of-pocket costs.
• Consider paying your estimated balance due before your appointment to make your appointment check-in faster.

Make your appointment online through My Health at Vanderbilt or call your physician's office. You will be asked to provide some information, such as identification and insurance information. Once the provider has this information, the scheduling team can help you set an appointment time and date.

Before your appointment, you are encouraged to ask about the services you will receive. Asking for additional information can be helpful, as you can contact your insurance company to ensure that the services you will receive are covered by your insurance plan.

Before your appointment, the provider may contact your insurance company to obtain preauthorization of services or medications. At this point, your insurance company collects information about your appointment and medical records prior to determining whether the services or medications will be covered.

When you arrive for your appointment or admission, you'll probably need to complete paperwork required for registration. Be sure to bring your insurance card, your prescription list and a valid ID. Be prepared to pay any co-pay. 

At check-in, your financial responsibility as a patient will be explained. We can discuss payment options, including a payment plan. We also can connect you to a financial assistance counselor.

After your appointment or visit, VUMC sends an insurance claim to your insurance provider. This claim covers all the services, prescriptions and supplies used during your stay or appointment.

Your insurance provider reviews this bill and checks whether the services are covered by your plan. The insurance company may contact you or us to get more details. At this point, your insurance company decides to accept or deny the claim.

If the claim is accepted, your insurance company pays us. If it is denied, the company must give us a detailed reason for the denial. Then we will send you a bill for the balance.

You will receive monthly bill(s) for amounts greater than $10 that we determine are your responsibly after insurance payments have been applied. (You may receive more than one bill for your hospital or clinic visit based on the type of care you receive).

We do our best to get things right the first time. But given the coordination involved, mistakes sometimes happen. It is important that you read your bills carefully and contact us and/or insurance company if you may have been billed in error.

You have the right to dispute your charges and to have your bill reviewed to make sure charges are accurate and and supported by your medical record. You may request this review in writing to the correspondence address listed on your statement or by calling the billing team. 

For Vanderbilt University Medical Center or Monroe Carell Jr. Children’s Hospital at Vanderbilt bills, call the following numbers based on the first letter of the patient’s last name.

• A to K, call (855) 249-3628
• L to Z, call (877) 200-9630

After this review, we'll let you know the findings and make any corrections needed.

You have the right to appeal the decision. Request an appeal by writing to the address listed on your statement or by contacting customer service.

You also can request a detailed statement. You can do this through My Health at Vanderbilt or by calling customer service at the numbers listed above.

We will send you monthly bills for any unpaid balances for up to 120 days after you received services. During this 120-day period, we will contact you multiple times via statements, phone calls and/or emails to remind you about your unpaid balance.

During this period, you are expected to pay the bill in full or set up an interest-free payment plan.

To set up a payment plan for Vanderbilt University Medical Center or Monroe Carell Jr. Children’s Hospital at Vanderbilt bills, call the following numbers based on the first letter of the patient’s last name.

• A to K, call (855) 249-3628
• L to Z, call (877) 200-9630

For any other statements you may receive, contact the phone number shown on the bill.

If the balance due is unpaid or otherwise unresolved after the 120-day period, your account will be sent to a collection agency. Your credit rating may be affected if the balance is not resolved after collection agency placement.

By law, we must ask you a series of questions at each visit. The questions help us determine whether Medicare or another payer should be filed as your primary insurance.

You will be asked:

• If your visit is related to a non-work-related accident
• Other benefits you may have, including other insurance you may have
• Your employment and or your spouse's employment
• Your retirement date and or your spouse's retirement

If you are covered by Medicare, we will submit your claims to Medicare on your behalf. We will also ask you to sign a notice that you are financially responsible for the services we provide. This is just in case Medicare deems the services not medically necessary and does not cover the services.

Expect a bill to you and/or your supplemental insurance carrier for services not covered by Medicare, such as medications you give yourself and routine health exams. Expect to pay if Medicare or your supplemental insurance does not cover the services we provided.