Frequently asked questions and helpful definitions related to the billing process at Johns Hopkins All Children’s

I have more than one insurance policy. How do I know which insurance is primary?

For children covered under both the mother’s and the father’s insurance plan, the plan of whichever parent’s birthday (month and day only) comes first is the primary insurance policy.

If two or more policies or plans cover the dependent child of divorced or separated parents, benefits for the child is determined in this order:

• First, the policy or plan of the parent with custody of the child;
• Second, the policy or plan of the spouse of the parent with custody of the child;
• Third, the policy or plan of the parent who does not have custody of the child.

Learn more about insurance plans accepted by Johns Hopkins All Children’s Hospital.

My child is receiving therapy services and I do not understand the billing cycle.

For children who are receiving therapy services, the assigned account number will remain open for up to 90 days before the account is discharged and a new account number will be established if services are continued. Bills will be mailed on a per-service basis or will be sent monthly depending on the insurance.

Why do I keep receiving a bill when I have already provided a copy of my insurance?

Johns Hopkins All Children's Hospital sends itemized bills as required by Florida Statute 395.301. This bill is used to notify the guarantor (the guarantor is the person—often the parent or caregiver—responsible for paying for services on behalf of the patient) of the specific nature of charges or expenses incurred. If you’ve provided us with your insurance information, we have submitted these charges to your insurance plan for payment. Learn more about the billing process.

I received notification that my account was referred to a collection agency. Why is this?

Once your insurance company has completed claims processing, any remaining balance that you’re responsible for paying is sent to our extended business office. You’ll then receive monthly billing statements and may also be contacted by phone. If we don’t receive your payment, or you don’t contact us to work out a payment arrangement, your account may be referred to a collection agency. Learn more about financial assistance and payment plan options.

How does my child’s doctor decide if he/she needs to be admitted to the hospital?

You child’s physician decides if he or she needs to be admitted and receive in-patient services depending on factors like the severity of the illness and the care required. This is a clinical decision made by your child’s care team, including the physician, nursing staff and other clinical staff involved in your child’s care.

I went to the Johns Hopkins All Children's Outpatient Care Center. Why did I get a bill from the hospital?

Our Outpatient Care Centers are departments of the hospital, so the services that were provided are submitted as part of Johns Hopkins All Children's Hospital.

What’s the difference between hospital services and physician services?

Hospital services include inpatient services, services received in our Outpatient Care Centers and other services such as lab tests, echocardiograms, MRIs or pharmaceuticals received as part of care. Physician services (also sometimes referred to as professional services) include services provided by a physician, nurse practitioner or physician assistant.

Costs for services will be billed under each entity.

For hospital services it will be under, Johns Hopkins All Children’s Hospital. For physician services they can be billed under Pediatric Physician Services (PPS), West Coast Neonatology, depending on the services received. It’s common to receive multiple bills when medical services are rendered. 

University of South Florida physicians and other private physician practices also provide care to patients at Johns Hopkins All Children’s Hospital. You may receive a separate bill from them for the services they provided.

Learn more about the billing process.

Why did I have to pay a co-pay at the time of my child’s appointment?

Many insurance plans will require a co-pay for each of the health care providers your child sees. Your child’s provider may also determine that additional testing is necessary. In this case, if these services are provided at one of the Johns Hopkins All Children’s Outpatient Care locations, you’ll be billed separately from the physician bill for these services. These services are billed to your insurance as an outpatient hospital service and may incur a deductible or coinsurance.

How do I request an estimate for services?

In order to provide you with the most accurate estimate possible, it is helpful for you to provide us with the applicable diagnosis and procedure codes, which should be available from your referring physician. Upon request, a written estimate will be provided.

Requests for estimates are not binding, and are subject to increase or decrease based on the actual services provided, as each patient is unique and your child’s health care needs may vary depending on the complexity of his or her condition. Estimates are based on charges for hospital services and may not include physician fees unless requested.

To request an estimate, including a self-pay estimate, please call our Estimate Unit at 844-986-1584.

Learn more about additional resources for determining estimated costs of care.

Billing definitions

Below you’ll find definitions and further explanation of some common words or phrases you may encounter during the billing process.

Admission date: The date when the patient began receiving medical services.

Appeal: A process in which either the patient, parent/caregiver, hospital or doctor disputes the final determination from your insurance company for payment or denial of payment for services rendered.

Assignment of insurance benefits: An agreement that is signed by the guarantor (the person—often the parent or caregiver—responsible for paying for services on behalf of the patient) that allows the hospital to be paid directly by the insurance company.

Billing date: The date when the bill was generated.

Claim: A bill that is submitted to the insurance company for reimbursement.

Claim form: The form used to submit charges to the insurance company for reimbursement.

Claim number: The number assigned by the insurance plan that is used to track a claim.

Co-insurance: A percentage of the total charges that the guarantor is responsible for paying.

Co-payment: A fixed dollar amount that the guarantor must pay prior to specific medical services being rendered.

Contractual adjustments (C/A): The portion of the bill that the hospital does not charge the guarantor for, as previously agreed upon between the hospital and insurance company.

Coordination of benefits (COB): A practice used by insurance companies to verify any and all health insurance policies that may cover the patient. Many insurance companies will not pay a claim without this information. Learn more about COB.

Covered benefit: A medical or health related service that is covered by your insurance policy. These services are covered by your insurance company either wholly or partially, depending upon your benefit levels. For more information on your covered benefits, please contact your insurance company directly.

Deductible: A specific dollar amount that the guarantor must pay before the insurance company will begin paying.

Discharge date: The date when the patient was discharged from the hospital or the last day the patient received services.

Estimated insurance due: The date when the hospital anticipates the insurance company will pay for services rendered.

Explanation of benefits (EOB): A document or statement from your insurance company after a claim has been received and processed. This document explains how a claim has been paid or will be paid, and identifies what portion of the bill you are responsible for.

Guarantor: The person who signs the Johns Hopkins All Children's Hospital consent and is responsible for paying all charges for services ordered on behalf of the patient.

Itemized bill: A bill provided to you from the hospital that shows all charges associated with the care your child received. This bill indicates the specific charges that have been submitted to your insurance if insurance information was provided.

Medical record number: A unique identification number that is assigned to each patient.

Non-covered services: Medical services that are not covered or payable by your insurance company. The guarantor may be responsible for the associated charges.

Non-participating provider: A provider who has not entered into an agreement with an insurance plan and, therefore, is not part of the insurance or health network.

Participating provider: A physician or hospital that has come to an agreement with an insurance plan to accept the insurance payment as payment in full, less any patient responsibility such as deductible, co-insurance or co-payments.

Patient account number: A number that is assigned to the patient in order to identify a specific account or date(s) of service.

Patient accounts: The area of the hospital that handles the hospital billing and collection aspects of the patient's care.

Personal financial statement of guarantor(s): A form completed by the guarantor that indicates the guarantor's income, number of persons in the household and total out-of-pocket hospital expenses over the past 12 months.

Prior authorization: A number assigned by the insurance company that indicates approval for certain medical services or treatments to be rendered.

Professional billing: The area of the hospital that handles the billing and collection aspects of the patient's care as it relates to the hospital-employed physicians.

Referral: Some insurance companies require a referral or approval from your primary care doctor before you can receive care from outside medical services and specialists.

Remittance advice: An explanation from the insurance company that is sent to the hospital, usually accompanied by payment, after the claim has been processed.

Service date: The date(s) when care was provided to the patient from the hospital or provider.