From questions about facility fees to insurance coverage, we’ve outlined some of the questions you might have about paying your bill.
If you don’t see your billing questions answered here or prefer to schedule an appointment to discuss your bill in person, don’t hesitate to contact us at 855-827-3633, Monday through Friday from 8 a.m. to 4:30 p.m.
If you call after hours, please leave a message with your name, date of service and account number. Your call will be returned the next business day.
Note about your privacy: In April 2003, a federal act called the Health Insurance Portability & Accountability Act (HIPAA) went into effect that protects patient information. The hospital cannot release ANY information concerning your medical record, including financial information, to anyone but you, a legal guardian for patients under 18 years of age, and/or a conservator without written permission unless specifically permitted by law.
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Facility Fees for Outpatient Medical Bills
The facility fee is an indirect cost for a suite of services delivered at a hospital-based clinic or physician office. Facility fee costs include, but are not limited to, using a room or space, having access to state-of-the-art medical equipment and advanced technical resources, and the use of supplies. A hospital-based clinic offers the best healthcare possible.
A hospital-based outpatient clinic is a hospital-owned clinic that is licensed by the State Department of Public Health and is subject to inspections. The clinic can be located on or off the main grounds of the hospital, and must be owned and operated by the hospital. When you are seen in a hospital-based clinic, the facility fees for the services you receive will be represented in the hospital bill.
Facility fees are very common in the health care community and have been part of the billing process for decades. The American Hospital Association provides the following justification in support of facility fees to ensure patients have continuous access to medical care:
- Hospitals provide access to critical hospital-based services that are not otherwise available in the community and treat higher-severity patients.
- Hospitals have higher cost structures than physician offices due to the need for access to emergency services.
- Hospitals have more comprehensive licensing, accreditation and regulatory requirements than physician offices.
Facility fees are based on the range of services provided and the complexity of care. In some cases, the facility fees may be equal to or greater than the cost of your other charges. For an estimate of these types of fees prior to receiving services, contact a specialist:
- UC San Diego Health price quote line (toll-free): 844-827-3411
- UC San Diego Health price quote line (local): 858-657-8380
- Email: email@example.com
When services are rendered at a hospital-based clinic, the patient receives two separate bills. One bill reflects the hospital charges and/or facility fees, and the other bill reflects charges from the physician. If, however, services are rendered at a physician office (or clinic) that is not owned and operated by that hospital, then all charges are combined onto a single statement.
Please note that some specialty services may also yield separate bills. Examples include infant hearing tests or a specialty physician’s interpretation of lab results. Those care providers or facilities will bill directly for their services.
Receiving treatment at this type of hospital-based location may indeed affect the copayment and deductible amounts calculated by your health plan. Contact your health plan directly for an estimate of the costs prior to receiving services.
When you schedule an appointment, simply ask if the type of service(s) could be performed in a physician office instead of a hospital-based clinic, or in an area where a facility fee would not be charged. Understand that this may affect available dates, times, and locations of the services.
If your primary care provider is located in a hospital-based location, a facility fee may be applied, even for the same type of service(s) you received previously. For a list of UC San Diego Health’s hospital-based locations, please ask a scheduler or a front desk representative.
General Billing Questions
In general, multiple bills will be for different parts of your doctor visit. If you look at the top of each bill, you may see that one is from UC San Diego Medical Group for services provided by your doctor. You may also receive a separate bill from UC San Diego Health for hospital services, such as lab tests, radiology or nuclear medicine.
For example, if you had lab work done at the time of your visit, you may receive the following three bills: one from your doctor’s office for your clinic visit, one for the lab work, and one from the pathologist reading the lab tests.
If you believe you've received a duplicate bill or if you have any other questions about your bills, contact one of our billing representatives. The provider of the service is located in the top left corner of the bill:
- UC San Diego Medical Group (physician services): 619-543-3000
- UC San Diego Health (facility services): 855-827-3633
Our financial policy is to collect any patient payment responsibility prior to the service being rendered.
There are two common reasons that this may occur.
First, it may take a few days to process the payment and apply it to the charges for your visit. If you believe this is the case, it is best to contact the provider listed at the top of your statement.
Alternatively, your payment may have been applied as a deposit at the time of check-in, and a statement was sent for the remaining balance (after your health insurance plan processed the claim). Again, it is best to contact the provider listed at the top of your statement for a full explanation.
After your health insurance plan processes the claims, there may be additional copayments. Make sure you retain the receipt(s) for all payments, and contact the provider listed at the top of your statement for additional questions.
For most insurance health plans, the deductible for the primary health plan must be met before the secondary health plan will pay for services. It is best to contact the provider(s) at the top of your statement(s), or your health plan directly, to inquire if both health plans have been billed and the deductible calculation is accurate.
The hospital refers some ancillary services to outside medical professionals. For example, we may send laboratory tests to outside physicians for additional medical opinions. In addition, x-rays are read by specialty radiologists. These (and other physicians) may bill you directly.
Please call our customer service department, 855-827-3633, between 8 a.m. and 4:30 p.m. Monday through Friday. If you call after hours, please leave a message with your name, date of service and account number. Your call will be returned the next business day.
Physician services are not included in the billing that UC San Diego Health submits to your insurance, nor are they included on the patient billing statement you receive. You may receive separate billing for services from:
- Primary care physician
- Emergency Department physicians
- Specialty physicians (i.e. cardiologists, pulmonologists, ENT physicians, etc.)
You can pay online through MyUCSDChart. Log in or set up an account at
http://MyUCSDChart.ucsd.edu and look for Billing in the left sidebar.
Patient financial responsibility is determined by your specific insurance policy. Prior authorization for services may or may not be required. A Patient Access representative or financial counselor is available to assist you with an estimate of what you will owe. UC San Diego Health's financial policy is to collect co-pays, deductibles and Medi-Cal Share of Cost (SOC) prior to or at the time of service.
Please call our customer service department at 855-827-3633, and we will send you a copy of your itemized bill.
Even if you have authorization for a service, you may still have a financial responsibility. The amount you owe is determined by your health insurance coverage. UC San Diego Health verifies your insurance eligibility and benefits, then determines your financial responsibility, if any. Your policy may require a co-payment, deductible, share of cost, and/or out-of-pocket maximum to be met before coverage is effective.
Patient Financial Services will work with you to resolve any billing discrepancies that may occur. If there is an overpayment to your account, it will be transferred to other open self-pay outstanding balances (either for UC San Diego Health and/or UC San Diego Medical Group). The refund of any remaining overpayment will be sent to the patient/guarantor. If the overpayment is due to a payment from a credit card, the first priority will be to send the overpayment back to the credit card issuer; otherwise, a check will be issued to the patient/guarantor. Please allow 6-8 weeks for the overpayment to be processed.
If you believe you have made a payment in error or have any other issues or questions related to your payment history with UC San Diego Health, please do not hesitate to contact us.
You will receive an Explanation of Benefits (EOB) from your health insurance carrier describing the services they have been charged, the amount they were charged, and the amount that was paid by the insurance carrier. The EOB is not a bill.
UC San Diego Health will make every attempt to ensure that the service(s) we provide has been authorized by your insurance prior to the service(s) being rendered. Not all insurance companies will provide a pre-authorization; therefore, it is UC San Diego Health's expectation that you are familiar with your insurance benefits.
If you are unsure of your medical benefits, call your insurance company to find out if the service(s) you need are a covered benefit. If authorization for service(s) is denied by your insurance carrier, we will inform you. At that point we can provide a quote and make payment arrangements, if necessary.
It is in your best interest to know and understand your plan benefits, as well as any deductible and co-payment amounts that you are responsible for paying. If you do not understand your coverage, we recommend you contact your insurance carrier. They should be able to explain if the service is covered or not. You can also contact a UC San Diego Health financial counselor to review your benefits with you.
Yes, you are financially responsible and will be billed for services not covered by your insurance. If you cannot pay the full balance due, you may call customer service, 855-827-3633, to discuss a payment arrangement.
All charges for doctor visits and any other services you receive are sent to your insurance carrier as a claim. Unfortunately, although we attempt to get pre-authorization, we do not always know in advance whether those services will be covered by your insurance. Claims that we submit to your insurance carrier are paid based upon your individual benefits.
Most health insurance claims are processed without problems. However, insurance carriers are becoming more watchful of costs. This sometimes results in services that were previously covered no longer being covered. Any non-covered services must be paid for by you. We recommend you call your insurance company, read your health care benefits coverage information carefully, and do your research so you understand what is covered under your plan.
Please note that our lab is a hospital-based facility so your claims will be processed as outpatient hospital benefits. This can make a difference in how some insurance plans process your claims, especially if you have a PPO plan with a high deductible. If you would like to have lab services performed somewhere else, please let your doctor know.
UC San Diego Health accepts many insurance carriers. Each insurance plan is different. Please contact your new insurance to ask if they will cover your current doctor. Some patients have found it helpful to have our tax ID numbers available during the discussion with their insurance providers. For convenience, the tax ID number for UC San Diego Medical Group is 23-7064656 and the tax ID number for UC San Diego Medical Center is 33-0599494.
Some health care insurance plans have recently shifted financial responsibility to the patient for some common services. The following services are often not covered or only partially paid for by insurance:
- Preventive visits and annual exams, including well woman checkups
- Lab tests associated with preventive visits, annual exams and well woman checkups
- Physical exams for travel, school or work
- Flu or pneumonia vaccines
- Immunizations and travel vaccinations
- Infertility counseling
- Osteopathic manipulations
- Behavioral health and weight management services
- Dermatology services, including wart, mole and skin tag removal
- Birth control
- Tuberculosis (TB) screenings
- Screenings for HIV and sexual transmitted diseases (STDs)
- X-rays and electrocardiograms (EKGs)
- Radiofrequency ablations (RFAs)
- MRI and CT scans
A financial counselor can assist you with making payment arrangements prior to receiving medical services. They will work with you to determine whether or not you are eligible for a Letter of Agreement. If you cannot make payment arrangements or do not contact a financial counselor regarding making arrangements, your medical service may be deferred until acceptable arrangements have been made.
If you do not have health insurance, please contact our Patient Financial Services team at 855-827-3633. They can assist you with the application process for public assistance programs, including County Medical Services (CMS) or state programs such as Medi-Cal.
UC San Diego Health will provide discounted pricing to uninsured patients who do not qualify for charity assistance. The discount is equal to 45 percent of the estimated gross charges for anticipated hospital services. The discount will be automatically applied at the time of billing to all accounts designated as “Self Pay” when charity assistance criteria are not met.
Speak with a financial counselor before medical services are provided, whenever possible, or before being discharged from the hospital.
The Patient Financial Services team is dedicated to helping patients and physicians determine sources of reimbursement for hospital services.
As a private, non-profit institution, UC San Diego Health relies on patient care revenues, commercial insurance, government programs or direct patient payments.