If you want to know how much the care your doctor wants you to have will cost, we can provide you with an estimate of the cost of care. An estimate is not the exact cost, but it will give you an idea of your cost after your insurance covers their portion. To get an estimate, you can call us at:

For your estimate:
Visit UMiamiHealth.org/Estimates
or call 305-326-6486, option 4.

When you and your doctor decide you need a procedure or surgery, we can estimate how much you may need to pay. An estimate of your bill will give you an idea of how much you may owe and how much your insurance will cover.

We create an estimate based on information from your insurance plan. This information includes how much of your deductible you have left to pay, what co-payments or co-insurance you have, and how much your insurance will pay.

We use the insurance information we obtained on the day we created your estimate. This information may change after that day.

Check with your insurance company for the most up-to-date information on what you must pay.

If you do not have insurance and need to “self-pay,” we can provide you with a Good Faith Estimate for the costs of your care. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Your estimate includes standard costs of care for the procedure or surgery you are having:

• Care provided by nurses and other hospital staff (not the cost of care for your doctors and Advanced Practice Providers)
• Hospital room and food
• Supplies and equipment.

It is not a complete list of your care costs. Your estimate does not include the costs of your medicine, or care and equipment you may need after you leave the hospital.

If you need care that is not part of the standard costs, your actual costs may differ from the list on your estimate.

Your final bill will include all services you received, which may vary from the estimate.

We include the cost of your UHealth doctors’ care as part of the estimate.

Your estimate will be on your MyUHealthChart before your procedure or surgery.

On the day of your procedure or surgery, you can ask the Patient Access Representative for a copy of your estimate.

You can always call for an estimate. The contact information is:

For your estimate:
Visit UMiamiHealth.org/Estimates
or call 305-326-6486, option 4.

You can find the contact information on your last After Visit Summary.

We will call you with an estimate if you plan a high-cost procedure, surgery, or certain procedures.

Our goal is to be clear and upfront about our pricing and what you need to pay. We want to help you plan for the healthcare you need.

To create an estimate, we will need:

• A description of what you will be having and the CPT code.
• Ask your doctor's office for the name of the procedure or surgery and ask them for the CPT code for it. (a code with 5 numbers)
• The name of the doctor ordering the procedure/surgery.
• Date of procedure if scheduled.
• Your insurance card information:
• Member id number
• Group number
• Your insurance plan's phone number
• Subscriber (policyholder) name, Date of birth, and Social Security Number
• Where you will have the procedure/surgery.
• Knowing your deductible, co-payment, and co-insurance amount will help us create your estimate.

Your estimate includes standard costs for care needed for the procedure or surgery you are having. However, if you need care not part of the standard costs, your actual costs may differ from your estimate. Your final bill will include all services you received, which may vary from the estimate.

Please plan to pay the estimate you owe when you arrive for your procedure or surgery. We will send a final bill after we receive payment from your insurance plan.

UHealth owns and runs hospital-based clinics (HBC), also known as "provider-based clinics." It's common for large healthcare systems like UHealth, which owns and operates both hospitals and clinics, to have hospital-based clinics. When you see a doctor or receive care at an HBC, your bill includes costs based on a hospital visit because the hospital-based clinic is a part of the hospital.

How is it different from a stand-alone doctor's office, radiology (X-rays, MRI, CAT scans, etc.) service, or laboratory (lab)?

A stand-alone doctor's office, radiology service, or lab is not part of the hospital. Some clinics may have the University of Miami Health System name but are not hospital-based.

Your bill will include different items for an HBC than a bill for a stand-alone doctor's clinic, radiology service, or lab.

You will receive a bill from the HBC that may have 2 charges.

1. The hospital charges
2. The professional charges, or "provider fee," for the doctor's care.

A stand-alone doctor's office or clinic will add charges for all your care on one bill and does not include hospital charges.

When you visit the hospital or a HBC, your visit will include both a hospital and professional claim(s).

1. The Hospital Charges include:
• Cost of nursing and other non-doctor medical staff,
• Supplies and equipment,
• Treatment rooms,
• Other building costs
• Tests and procedures.
2. Professional Services are the cost of the doctor's care or other provider's care, such as the Advanced Practice Provider care.

Your insurance plan will provide the best answer for how much you will owe. You should review your insurance benefits or contact your insurance plan first.

Based on your health insurance plan, you may or may not have higher out-of-pocket costs when you get care at a hospital-based clinic. Your bill shows the actual services you receive. The bill will also show the amount your insurance plan covers and how much you need to pay based on your deductible, co-insurance, or co-payments.

Your health insurance plan may pay for care HBCs provide in different ways than care by a stand-alone clinic.

Please ask your insurance plan how they cover "facility fees" (clinic charges or clinic fees).

Your insurance plan may or may not allow facility fees.

If your insurance allows facility fees, they may cover them under the hospital benefits portion of your plan rather than the physician(doctors) benefits portion.

This may change how much you will pay for your visit. You may need to pay a percentage(part) of the bill (also called co-insurance) and/or meet your deductible before your insurance will pay.

You will not have to pay this charge if your insurance does not allow facility fees.

If you have private or secondary health insurance, ask your insurance company:

• Does my plan cover hospital/facility charges in a hospital-based outpatient clinic (or a "provider-based clinic")?
• How are "facility fees" (Hospital/clinic charges or hospital fees) covered?
• What percentage of the charge does my insurance cover?
• If my plan covers facility fees, what part do I pay out of pocket based on my deductible?
• What percent of the bill do I pay based on my co-insurance?

How much UHealth charges for facility fees will depend on a few items:

• How long your visit is.
• The services you have during your clinic visit.
• The cost of supplies and equipment used during your visit.

You can call the UHealth team at 305-326-6486, option 4, for an estimate of the facility fees and other costs. Please read Before you call about an estimate, please have this information nearby to make sure you have the details we need to create your estimate before you call.

You can also get an online estimate of charges for your care on the UHealth Pay a Bill webpage.

This online tool will show hospital charges/facility fees as "Hospital Fees."

The amount of the facility fee that you will pay depends on what your health insurance covers.

You should contact your insurance company and ask:

• How do they cover HBC visits?
• How much will you need to pay based on your plan, including co-payments, co-insurance, and deductible amounts?

We will collect the amount you owe before you visit your doctor.

You may discuss payment options when you arrive for your visit. If we call you before your visit, you can discuss your payment options with a financial care counselor.

When you call to schedule your appointment, the person who helps you can tell you if the clinic is hospital-based.

Signs at the clinic will also tell you the clinic is a hospital department.

As part of your pre-service check-in you will receive a hospital-based facility notice.

If you are unsure if you are at an HBC or have questions, feel free to ask the front desk or clinic staff when you arrive.

Surprise billing is a bill you receive for medical care from a doctor, advanced practice provider, or health care facility who is outside your health insurance plan's network of approved providers list. And when you see them, you do not know they are out of network.

This can happen when you go to an emergency room that is not in your network or when an emergency room doctor who is not in your network treats you.

Surprise billing is not when your bill differs from your estimate for a procedure or surgery. We base your estimate on the standard costs of the procedure or surgery. If you require more care or supplies during your stay than is standard, your bill may be higher than your estimate.

The No Surprises Act protects you from Surprise billing.

A test is either a screening or diagnostic test, depending on why and when you are having it. Tests such as a Mammogram and colonoscopy may be either screening or diagnostic.

Screening Test:

• Your doctor will order a screening test as part of your wellness plan. It is a routine test sometimes done every year when you do not have symptoms.
• Check with your doctor and insurance company to see when you should get a screening test.
• The timing of your screening may depend on your age, gender, and family history.

Your screening test may become diagnostic if the doctor finds something unusual.

Diagnostic Test:

• Your doctor will order diagnostic tests if you have symptoms to help find a reason for your symptoms.
• Your doctor may order a diagnostic test if something unusual shows up on a screening.

You will need a referral or doctor’s order for a screening or diagnostic test at UHealth.

Screening Test:

• You will need a doctor’s order for your screening test.
• Please check with your insurance company.

Diagnostic Test:

• You may need a referral from your doctor for a diagnostic test.
• Please check with your insurance company.

Screening Test:

• Your insurance plan usually covers a screening without a patient co-pay.
• Your insurance company can tell you which screening tests they cover and how often.
• Call or email them to confirm.

Diagnostic Test:

• Your insurance plan usually covers a diagnostic test but may require you to get an authorization.
• You may need to pay a co-pay or other out-of-pocket costs.
• Your insurance company can tell you which diagnostic tests they cover and what information they need to cover it.
• Call or email them to confirm.

Your visit is a regular or routine visit when you visit your doctor or Advanced Practice Provider (APP) when you are sick, injured, or have a new health concern. For this visit, you pay your deductibles, co-pays, and/or co-insurance based on your insurance plan.

A wellness visit is a check-up when you are not sick, injured, or have a new health concern. The goal of a wellness visit is for you to learn about your health.

• You and your doctor or APP create a plan to stay as healthy as possible.
• You meet with your doctor or APP (Advanced Practice Provider such as a Nurse Practitioner or Physician Assistant) when you are not sick or injured.
• You and your doctor or APP have time to do a full health check-up and complete health screenings.
• You will also discuss your well-being and health risks.
• Depending on your age, you may have:
• Complete check-up
• Immunization review and update
• Heart disease screenings (blood pressure, blood sugar and cholesterol tests)
• Cancer risk screenings (pelvic exam, Pap smear, prostate, and colon cancer screenings)
• Sexually transmitted disease (STD) testing
• Screening for depression
• Most insurance companies pay 100% of a wellness visit every year or every other year. Usually, you do not have to pay for a wellness visit.

Your insurance may consider your wellness visit a regular office visit if, during your wellness visit:

• You ask your doctor or APP about a recent illness, injury, or new health condition.
• You have any test, procedure, or treatment that is not for screening but for finding out what illness or injury you have or treating your illness or injury.
• If this happens, you may need to pay your deductibles, co-pays, and/or co-insurance for a regular office visit.

A deductible is the amount you must pay for your health care each year before your insurance plan pays. For instance, if your plan has a $1,000 deductible, you must pay the first $1,000 for covered visits and care. Once you have paid this amount, you may still need to pay co-payments or co-insurance for covered care. Your insurance company will cover the rest.

A co-payment is a fixed amount for a covered healthcare visit or medicine. You may have a certain dollar amount you pay for your primary care visit and another amount for visits to other types of doctors, Urgent Care, and emergency room visits. You may also have a co-payment for your medicines.

After you have paid your deductible, you may still need to pay your co-insurance. This is a percentage (portion) of the total cost of care you pay after meeting your deductible amount. For example, if your plan allows $100 for an office visit and your co-insurance is 20%, you will pay 20% of $100, which is $20. The insurance company will cover the rest. If you still need to meet your deductible, you pay the total amount of $100. If you have paid your deductible, at the time of your visit, you pay $20.

Your insurance plan will let you know how much the out-of-pocket limit is. This limit is the most you must pay for health care in a plan year. After you reach this amount with your deductibles, co-payments, and co-insurance, your health plan pays 100% of the costs of covered care. The out-of-pocket limit does not include the monthly amount you pay for your insurance. It also does not include the amount you spend on care your plan doesn't cover.