UTMB Health’s Financial Clearance Policy
Understanding your financial responsibility before receiving healthcare services can be a confusing process. UTMB’s Financial Clearance Policy helps to navigate this process and ensures a consistent and positive patient experience across the UTMB Health organization. The following information is provided by UTMB Health to help answer questions you may have related to your visit.
Determination of Expected Financial Responsibility
We strive to review your expected financial responsibility with you prior to your scheduled service. You may receive a call from our Preservice Staff who will explain the estimated amount you may owe. Final charges may vary due to the actual treatment at the time of service.
Patient Financial Responsibility
UTMB Health requires a deposit be made by the time of service for any amount not covered by insurance, including deductibles, co-payments, and co-insurance. Payment toward an outstanding balance or bad debt may also be required by the time of your upcoming service. If you do not provide us with insurance information or you do not have active insurance coverage, payment for services is your responsibility.
If you are unable to make a deposit prior to service, your visit may be rescheduled to a time that is more financially convenient for you.
If you have active health insurance that does not cover your upcoming service (i.e., you have an out-of-network plan, your service does not meet Medicare’s medical necessity guidelines, or the service is not included with your plan), you have the following options:
- Cancel service and reschedule with a contracted provider.
- Reschedule for a similar service that may be covered by your insurance.
- Pay your responsibility, committing you will be responsible for total charges if your insurance does not pay the bill.
Your insurance may require pre-authorization for certain services before you receive them. The Preservice Staff will work to verify your insurance and obtain pre-authorization for scheduled services to determine if your insurance company will pay for your treatment. We will try to notify you prior to your scheduled service if pre-authorization has not been obtained. While this does not happen often, insurance plans vary, and sometimes there can be a delay before approval can be obtained.
If pre-authorization has not been obtained before your service, your service may be rescheduled to allow more time for authorization to be obtained. Without authorization for services from your insurance company, you would be responsible for the total charges and payment would be required prior to service.
Coinsurance: The amount that the Plan pays for services (after any noted deductible) with the insured member responsible for the remaining portion. For example, a plan with 80% in-network/60% out of network benefits would pay 80% in-network and 60% out of network. Therefore, the insured member would be responsible to pay the remaining 20% in-network and 40% out of network.
Copayment/Copay: A flat fee that is paid by the insured member for services applicable to office visits, Emergency Room visits and Admissions including Observation.
Deductible: A set amount that the insured member is responsible to pay before the Plan will pay any coinsurance