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?
- What portion of my healthcare expenses am I responsible for?
- What are provider-based clinic services?
- What if I do not qualify for Financial Assistance?
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.
- For more details, please review our Billing and Collections policy.
What are provider-based clinic services?
WVU Hospitals owns several provider-based clinics. Provider-based refers to services provided in hospital outpatient departments that are clinically integrated with the hospital.
Provider-based status is a designation for hospitals and clinics that meet specific government regulations and requires that we bill Medicare and other payers in two parts:
- One bill for the physician service
- Another for the hospital/facility resources and services
- Need help?
- Connect with our financial experts.
- Price Estimates
- Learn how we can help you estimate the cost before your visit.
- Payment Plans
- We offer zero interest payment plans.
- Bill Payment
- Pay your bill online with your MyWVUChart account.
- WVU Medicine Financial Policy (PDF)
- Billing and Collections Policy (PDF)
- Financial Assistance Policy (PDF)
- Plain Language Summary (PDF)
- Providers Not Covered Under WVU Hospitals’ Financial Assistance Policy (PDF)
- Medicare Information
- Other Resources