Insurance & Billing

Statements & Payments

Billing Statement Overview

UTMB Health provides a single statement for the health care services it provides. The statement combines fees related to clinic visits, hospital stays and other related charges.

The first page of the statement shows a summary of your outstanding balance due and due date. 

Please be aware that you may receive a statement from non-UTMB service providers, including emergency room physicians, hospitalists, intensivists, or anesthesiologists. Any of these may bill separately for their services. If you have a question regarding your statement from any of these physicians, please contact them at the phone number located on the statement they send to you.

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Hospital Costs and Charges

If you are considering a hospital procedure and are interested in an estimate of the cost, or are comparing costs among different providers, the following information should be helpful for you, including a definition of the hospital "chargemaster."

Insurance & Billing

  • General Charge Information and the Chargemaster

    A hospital “chargemaster” is a comprehensive listing of items that can be billed to a patient, payer or other entity. The charges listed in a health care organization’s (like UTMB Health’s) chargemaster are the amount set before any discounts. Providers, by law, are required to use uniform charges as the starting point for all bills.

    The chargemaster prices are for admission to or for the use of hospital services only. The price typically is intended to cover costs for hospital infrastructure, nursing, equipment, and general personnel. Charges for physician services are typically not included and are billed separately.

    Hospital charges are based on the actual care offered to each patient and the resources used to provide that care. Charges for the same condition can vary from patient to patient due to complications or different approaches to treatment needed due to an individual’s unique health condition.

    Also, remember when considering cost, that like with any product or service, price is but one of several factors to evaluate in your decision. You may want to consider quality, safety, experience, scope of available services and other measures in your deliberations.  

  • UTMB Hospital and Physician Standard Charges

    UTMB Health believes pricing transparency provides important information to help patients make informed healthcare decisions.

    While the information provided in these files does list service charges, it DOES NOT accurately reflect out-of-pocket patient costs, or the charges for services that may often be provided in conjunction with the service that is listed. To better understand those costs and your share of the charges, we encourage you to contact your insurance company, or send questions to the UTMB Estimates Team. The UTMB Estimates Team is the best way to get the most accurate estimate for services.

    Remember when considering cost, that like with any product or service, price is but one of several factors to evaluate in your decision. You will also want to consider quality, safety, experience, scope of available services, and other measures in your deliberations.

    UTMB Hospital Rates
    Download CSV file

    UTMB Physician Rates
    Download CSV file

  • Inpatient Care

    Charges for a hospital admission are typically grouped and paid by insurance companies as one lump sum payment.

    A listing of some common, high volume admission reasons and average charge per hospital stay are included below for your reference.

    The Average Charge most likely does not represent the amount you will be required to pay. If you have insurance, contact your insurance plan for specific information about your coverage for the needed hospital services, and to understand which portion of the charge may be your responsibility.

    Check your insurance card for applicable phone numbers or check the Insurance Plans Accepted by UTMB Health.

    MS DRG*MS DRG DESCRIPTIONAVERAGE CHARGES
    291Heart Failure Shock with Major Complications$28,272
    784Cesarean Section w/ Sterilization w/ CC$22,547
    787Cesarean Section w/o Sterilization w CC$22,590
    798Vaginal Delivery w/ Sterilization/DC w/o CC/MCC$22,042
    807Vaginal Delivery w/o Sterilization/DC w/o CC/MCC$14,913

    * Medicare Severity Diagnosis Related Groups On mobile devices, scroll to the side to see more information.

  • Outpatient Care

    Below we offer a listing of some common, high-volume imaging, lab and other outpatient procedures and the associated charges for each service, for your reference.

    The charge most likely does not represent the amount you will be required to pay.

    If you have insurance, contact your insurance plan or payor for specific information about your coverage for these or other needed outpatient service(s), and to understand which portion of the charge may be your responsibility.

    Check your insurance card for applicable phone numbers or check in the web page for Insurance Plans Accepted by UTMB Health.

    Common Radiology Procedures:

    PROCEDURE DESCRIPTIONCHARGE
    Ultrasound pregnant uterus after 1st trimester/First Gestation$514
    Screening Mammography$404
    Ultrasound Exam of Head and Neck$514
    Chest X-Ray, 2 View$249

    Common Lab Procedures:

    PROCEDURE DESCRIPTIONCHARGE
    Routine Venipuncture$51
    Urine Pregnancy Test$49
    Glucose Tolerance Test$99
    Complete CBC$60
    Urinalysis$29

    Other Common Outpatient Procedures:

    PROCEDURE DESCRIPTIONCHARGE
    Hyperbaric Oxygen Therapy$367
    Colonoscopy$4,368
    Nasal/Sinus Endoscopy Surgery$5,037

    On mobile devices, scroll to the side to see more information.

No Surprise Medical Bills

Insurance & Billing

  • Your Rights and Protections Against Surprise Medical Bills

    When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

  • What is “balance billing” (sometimes called “surprise billing”)?

    When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. If you see a provider or visit a health care facility that isn’t in your health plan’s network, you may have additional costs or have to pay the entire bill.

    “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

    “Surprise billing” can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

  • At UTMB Health, you’re protected from balance billing for:

    Emergency Services

    If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most we will bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You will not be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

    Certain services at an in-network hospital or ambulatory surgical center

    When you get services from an in-network hospital or ambulatory surgical center, it is possible some providers may be out-of-network. In these cases, the most these out-of-network providers will bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

    If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

    We’ll never require you to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

    When balance billing isn’t allowed, you also have these protections:

    You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

    Generally, your health plan must:

    • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

    Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law. The federal phone number for information and complaints is: 1-800-985-3059.

    If you think you’ve been wrongly billed:

    You may contact our UTMB Health Customer Service Office at (877) 463-0103 or (409) 515-7049, or send email to rcobilling.customerservice@utmb.edu.

    If you have a State of Texas regulated insurance plan or have coverage through the Texas employee or Teacher Retirement System, then you may have additional protections regarding surprise medical bills.  For more information, please visit https://www.tdi.texas.gov/medical-billing/index.html.

    For information or assistance with balance billing questions from the State of Texas Department of Insurance, visit https://www.tdi.texas.gov/medical-billing/surprise-balance-billing.html.

Insurance Claims and Payment Policies

All accounts are payable in full upon receipt of your statement. If you have commercial health insurance, your coverage will be verified, and a claim will be filed on your behalf. Our billing departments will cooperate fully with you and your insurance company to expedite payment of your claim. 

 

If there is a significant delay in claim payment, it may be necessary for UTMB to ask you to contact your insurance plan regarding your hospital or physicians’ bills.

Please remember that the patient or guarantor, not the insurance company, is responsible for the settlement of the account. Once your insurance payment has been received, any remaining balance is expected in full, within 30 days.

If you cannot pay your patient balance in full, it is possible to establish a payment plan. The term and payment amount is determined according to the amount owed. A customer service account specialist can assist you in establishing a payment plan. For more information, please call: 

 

For payment plan information, please contact our Customer Service Office at (877) 463-0103 or (409) 515-7049 or email RCObilling.customerservice@utmb.edu

Interest Applied to Billed Services

At this time, per its current policy, UTMB Health does not apply interest charges to bills issued for its clinical services.

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