Billing Resources & FAQs

If you received care within one of our clinics, hospitals or other locations, it's easy to pay your Virginia Mason Franciscan Health bill online:

• CHI Franciscan/Franciscan Medical Group patients: Online Bill Pay
• Virginia Mason Medical Center patients: Online Bill Pay

Although those services are part of your care at Virginia Mason Franciscan Health, based on the location your care was provided, the providers may bill for these services separately from the hospital or the clinic.

The only provider claims included in the Virginia Mason Franciscan Health patient statement are those providers employed by Virginia Mason Franciscan Health, Franciscan Medical Group, or Harrison Health Partners.

The most common reason is that your insurance benefits don’t cover 100 percent of what the insurance allows for your service. There are multiple reasons, including but not limited to:

• You haven’t yet met your deductible for the year.
• Your insurance only covers a percentage. For example, they’ll pay 80 percent and you have 20 percent left as your responsibility. We call this the coinsurance amount.
• You have a copayment, which is a flat rate dollar amount for that service, regardless of what your insurance pays. For example, many insurance companies have a co-payment amount, such as $50 for any emergency department visits.

Your insurance company will send an explanation of benefits (EOB) to you that will help you understand what they did or didn’t cover.

Depending on when you made the payment arrangements on your past bills and when you subsequently received services that weren’t part of those past invoices, you’ll need to call the Billing Office and add your newest bill to your payment arrangement agreement. For each new visit where you may owe a liability, once you have the new bill, you can add that to your payment agreement. As required, we must have your authorization to add that new balance to your previously set-up payment arrangement, because the new balance may also change the minimum amount due each month.

Especially for our patients for whom we’re billing insurance for payment of services, we depend on the timing of the insurance payment before we can bill you for your portion. In some cases, insurance payers will want additional information on one account and yet pay quickly on another. Once the insurance pays, we’re able then to either bill any applicable remaining balance to any known, applicable secondary payer, or move the balance to patient responsibility. When the balance is moved to patient responsibility, a statement is produced and mailed to you.

There are few reasons this could occur:

1. Statements are sent out based on automated scheduled times in the system. If your payment was mailed just prior to that scheduled date, the system wouldn’t have received it in time to stop the additional statement from being mailed.
2. Franciscan facilities have a new guarantor billing, all your accounts you’re responsible for paying are linked, so you may have multiple accounts on one bill. If you didn’t indicate the account you want the payment applied to on the check in the memo field, the system will automatically apply that amount to the visit that was the oldest billed to you. If you write the account number you want the payment applied to when you mail it in, the system will automatically assign that payment for someone to review, and we’ll manually post it to the designated account.
3. We have two different billing offices. One of our offices processes payments for services that occurred at our CHI Franciscan and Franscican Medical Group. The other billing office processes payments for services that occured at Virginia Mason Medical Center. If you made a payment and mailed it, please check which billing address you submitted your payment to.

We use multiple print vendors for our statements and letters depending on the type of statement and where the payment needs to be sent. Here are the current locations for return addresses you may see:

• Tacoma
• Dallas
• Alabama
• Seattle

All these statements and letters will have the Virginia Mason Franciscan Health logo.

To better serve you, we have teams specialized in handling your questions or needs. This normally ensures that we’re reducing wait times as much as possible. They’re all here to serve you and meet your needs, but if they can’t, they know how to get you to the right place. You should never feel a difference in the level of service regardless of whom you are speaking with. It should feel seamless to you; if it doesn’t, please ask to speak to a supervisor.

We understand that health care billing can be confusing and we’re here to help. If your question wasn’t answered by any of the above, please reach out to us. We’re committed to continuous improvement in our service.

• For services at CHI Franciscan/Franciscan Medical Group: 
  • Call 1-888-779-6380
    Monday through Friday 8 a.m. to 5 p.m.

• For services at Virginia Mason Medical Center:
  • Call 206-223-6601 or 1-800-553-7803 or TTY 206-344-7984
    Monday through Thursday from 8 a.m. to 5:30 p.m.
    Friday 9 a.m. to 5 p.m.
  • Connect via email
    Use our online form to connect with us about billing questions.
  • In Person
    Meet with a Financial Navigator at Virginia Mason Medical Center in Seattle.
    Monday through Friday from 8 a.m. to 4:30 p.m.

You should contact your insurance company, see our accepted insurance plans or contact our billing offices:

• CHI Franciscan/Franciscan Medical Group
  • 1-888-779-6380
  • Monday through Friday from 8 a.m. to 5 p.m.

• Virginia Mason Medical Center
  • 206-223-6601
  • 1-800-553-7803
  • TTY 206-344-7984
  • Monday through Thursday from 8 a.m. to 5:30 p.m.
  • Friday 9 a.m. to 5 p.m.

When a healthcare provider is “in network” it means the insurance company will cover a higher amount of the charges. When a provider is “out of network” you can still go to this provider, but you’ll be required to pay a larger percentage of the bill.

Yes, you’re expected to pay your co-payment when you arrive. Your insurance card should indicate the dollar amount of the co-payment required for each type of service. If you have questions regarding co-payment amounts, please contact your insurance company or your employer.

Yes, we’ll bill your insurance company for you, provided you’ve given us complete insurance information. This includes the name of the company, the address to which claims are to be billed, your policy identification number, your group number (if applicable), and a phone number.

Health insurance policies vary widely on which procedures, services, or items an insurance company will cover. To maximize your health insurance benefits, familiarize yourself with the policies and benefits outlined in your health insurance handbook or contact your health insurance customer service department for policy and benefit verification.

Questions to ask your insurance company:

• Am I covered for (service/item name)?
• What is my benefit maximum?
• Do I need prior authorization for (service/item name)?

Many insurance companies have amounts the patient must pay. These are called deductible, co-pays or co-insurance payments. If your insurance plan requires you to pay a deductible or co-insurance, the balance will be billed to you. If you have a question about why your insurance company didn’t pay part of a claim, call your health insurance company directly.

Surgeries and procedures:

There is a trend of insurances no longer paying for certain surgeries and procedures that are delivered in an outpatient hospital setting, that is, unless, due to medical necessity, the surgery or procedure, must be performed at the hospital.

Many insurances are now requiring these certain surgeries and procedures to be performed in the providers office, if appropriate, or an ambulatory surgical setting (ASC).

Many insurances are now conducting medical necessity reviews to determine whether an outpatient hospital setting is medically necessary for the surgery or procedure, in accordance with their policies and in terms of the patients benefit plan. This is referred to as “site of care” or “site of service” requiring hospitals/providers to submit a request for prior authorization to insurance for the certain surgeries or procedures scheduled in an outpatient hospital setting. If upon insurance review outpatient hospital is not considered medically necessary by the insurance, the location will not be covered under the patient’s plan.

If the insurance denies our prior authorization request to perform the surgery or procedure within an outpatient hospital setting, the surgery or procedure may need to be rescheduled into an ASC setting for the insurance to approve the surgery or procedure.

Imaging:

Please note there are also certain imaging services (MRI’s and CT’s for example) insurance may not deem as appropriate in a hospital setting. As such, we will follow the same processes as the surgery and procedures.
   

These are documents showing a detailed listing of how your insurance company processed your claim or bill. An EOB or EOP is mailed by your insurance company directly to you.