Billing Q&A

Our services fall under your insurance plan’s outpatient mental health benefits. While some insurance companies cover both medical and mental health benefits, other medical insurance companies “carve out” mental health benefits, by contracting with specialized insurers for mental health benefits. Your plan is determined by your employer who purchased the insurance plan, and the company providing insurance, and can change from year to year. Nationwide Children’s Hospital Behavioral Health is contracted with many medical and behavioral health insurance companies. We recommend you contact your insurance company directly to find out what your outpatient mental health benefits are before your first appointment, and at the start of a new benefit year. Copay or co-insurance is due at the time of service.

Through a contract with the Franklin County ADAMH Board, Nationwide Children’s Hospital Behavioral Health is able to offer a sliding fee to clients who live in Franklin County. Eligibility is determined by a family’s gross household income and number of dependents. To determine if you qualify, proof of income, such as the pay stubs, W-2’s, and tax returns, are required. Families who qualify will pay a percentage of our hourly rates. All client fees are due at the time of service. If you are eligible for a sliding fee, you may be encouraged to apply for Healthy Start, which provides full healthcare and behavioral health coverage for children. We also have Healthy Start applications available for families who wish to apply.

Through a contract with the Franklin County ADAMH Board, Nationwide Children’s Hospital Behavioral Health is able to offer a sliding fee to clients who live in Franklin County. Eligibility is determined by a family’s gross household income and number of dependents. To determine if you qualify, proof of income, such as the pay stubs, W-2’s, and tax returns, are required. Families who qualify will pay a percentage of our hourly rates. All client fees are due at the time of service. If you are eligible for a sliding fee, you may be encouraged to apply for Healthy Start, which provides full healthcare and behavioral health coverage for children. We also have Healthy Start applications available for families who wish to apply. 

We offer several payment options:

1. You may choose to use your MasterCard, Visa or Discover Card. If you have further questions or cannot pay the balance immediately, please call our Patient Account Representative at (614) 722-2055.
2. You may pay by cash, check or money order. Make the check or money order payable to the Nationwide Children's Hospital and be sure to include your account number. Mail to:

            Nationwide Children's Hospital
            Dept. 781117, PO Box 78000
            Detroit, MI 48278-1117

Before you call, have available your insurance card, date of service, facility name, original billed amount, patient name and claim number if applicable. Ask your insurance the status of your claim. If paid, ask when and to whom. Note this information and with whom you spoke at the insurance company. If the bill has not been paid, find out when the anticipated payment date is and ask if they need anything from you. If the bill is not paid in the stated timeframe, follow-up with the insurance company again and, if necessary, request to speak to a supervisor. 

The insurance company may send you an explanation of benefits (EOB) after your claim has been processed. The explanation of benefits lists the amount Children's Hospital billed the insurance company and the amount the insurance company paid on the claim. It may also list the contractual discount amount and the patient responsibility. If your claim is denied, the explanation of benefits will explain the reason for denial.

If there is a balance due from you after the insurance company has paid its portion, we will send you a statement. This statement indicates the amount that has been paid and any balance you are required to pay. This is your bill. You are required to pay this bill in full. 

See all of your options in the Financial Assistance Info section of our website.

See all of your options in the Financial Assistance Info section of our website.

If your account has been sent to a collection agency or attorney, please contact the collection agency handling the account to arrange for payment. Nationwide Children's Hospital refers accounts for collection only as a last resort. We send out two statements and make two phone calls asking for payment in full. If a proper payment plan has not been made, we will review the account for collections. On each statement we ask that you contact Patient Accounts to discuss questions about the bill or to make plans for payment. Patient Account Representatives can help you with this process Monday through Friday, 7:00a.m. - 5:00p.m. You may call (614) 722-2055 or email us at Children'sPatientAccounts@NationwideChildrens.org.

First, check to see if the insurance company that you had on that date matches the date of service on the bill. If it is the wrong insurance company, the Patient Account Representatives can help you Monday through Friday, 7 a.m.-5:00 p.m. Call (614) 722-2055 or email us at Children'sPatientAccounts@NationwideChildrens.org. 

If you disagree with the insurance company's payment amount, contact the insurance company and ask them to review how the claim was processed. If the insurance company finds that an error was made, note the information and to whom you talked to at the insurance company. Request an anticipated payment date and ask if they need anything from you. If the insurance company feels the bill was paid correctly and you still disagree, find out from the insurance company what you need to do to file an "appeal" with them. Filing an appeal will not guarantee that the insurance company will pay more on your bill, but the claim will be reviewed for reconsideration. 

If you receive several bills from Children's Hospital:
You may have had more than one visit to Children's Hospital. You will receive a bill for each of those services.

If you receive bills from Children's Hospital and other providers for the same date of service:
Doctors, anesthesiologists, and radiologists bill separately for the services they provide. If you have questions about a bill, please call the phone number listed on that bill.

You are legally responsible for your bill from the time you receive services from the hospital. We require all patient balances be paid in full immediately after you are notified.

If you verified your insurance information when you registered, you will receive a bill:

• If your insurance company pays the claim, leaving a coinsurance, deductible or non-covered services
• If your insurance company denies the claim
• If your insurance company hasn't responded to the claim

Doctors and other healthcare providers often send lab work to Nationwide Children's Hospital for processing. 

Most insurance plans require you to pay a deductible and/or co-insurance. In addition, you could be responsible for noncovered services. Please contact your insurance company for specific answers to your questions. 

You are ultimately responsible for the total bill or any portion of the bill your insurance carrier does not pay. Patient Accounts will make every effort to resolve the account balance with your insurance carrier. Occasionally, we will be unable to resolve the issue with your carrier and will need your assistance. 

Yes, as a courtesy we will bill your insurance company. It is your responsibility to provide any requested information to your insurance company (accident information, claim forms). 

Nationwide Children's Hospital will work with you to set up a payment plan that will meet your need. Patient Account Representatives are on hand to help you Monday through Friday, 7:00a.m. - 5:00p.m. at (614) 722-2055 or email us at Children'sPatientAccounts@NationwideChildrens.org. 

Please note: Nationwide Children's Hospital does not charge interest on balances due.