Below are some of our frequently asked financial/billing questions. Click on a topic to go directly to the answer.

What services are NOT covered by insurance?

Patients are responsible for services not covered by their plan. Every employer’s benefit plan is different. Please check with your plan before receiving scheduled services to ensure coverage.

WVU Medicine services that are not covered by insurance include:

  • Non-emergent service provided in an emergency room setting
  • Family planning
  • Cosmetic services
  • Services considered medically unnecessary

If you receive Medicare, please review the guidelines for details: CMS publication 11435.

What portion of my healthcare expenses am I responsible for?

Patients may have required out-of-pocket expenses for healthcare services. There are different types of out-of-pocket expenses.

  • Deductible: The amount paid annually before your insurance pays for its share of your services. Some services may be excluded from the deductible depending on your plan.
  • Copayment (Copay): Fixed expenses for each visit, such as a doctor’s office visit (e.g. $25) or emergency room care (e.g. $100).
  • Coinsurance: The percentage of medical cost that you are responsible for paying.
  • Out-of-Pocket Maximum: This is the maximum cost you are expected to pay in a single plan year.

What if I do not qualify for financial assistance or don’t meet the guidelines?

If you are unable to qualify for 100 percent financial assistance, you may still be eligible for discounted care. If you are uninsured, you will be charged 50 percent of billed charges for your hospital services. This discount ensures that you are not charged more than amounts generally billed for patients covered under Medicare or other private health insurers.

What are provider-based clinic services?

Some WVU Medicine hospitals own and operate provider-based-clinics. Based on regulations issued by the Centers for Medicare and Medicaid Services, “provider-based” refers to services provided in an outpatient clinic or location that is clinically and financially integrated with a hospital. Patients benefit because hospital outpatient clinics and locations are subject to additional quality standards and are monitored by The Joint Commission, an independent, not-for-profit organization that accredits and certifies healthcare organizations and programs in the United States.

The provider-based reimbursement model generates two separate bills:

  • One bill for the physician service
  • Another for the hospital/facility resources and services

Learn more about provider-based clinics.

Downloadable Files and Resources