Our goal is to make all financial communications clear, concise, correct, and patient-friendly. If you have any comments, feel free to contact us.
Understanding Your Bill
When your child is a patient at Nemours, you may receive two different bills: a hospital bill and a physician’s bill.
This includes charges for inpatient or outpatient services provided at a Nemours hospital. Charges may be related to:
- Inpatient stays
- Surgical procedures
- Observation admissions
- Emergency care
- Tests (e.g., X-rays, lab)
- Therapy (e.g., physical, speech)
Your physician bill includes charges for physician services provided at a Nemours specialty or primary pediatric office.
Common Medical Billing Terms
Some words and terms used in medical billing statements can be difficult to understand.
Here’s a quick reference of common medical terms you might come across.
- Claim: Medical services that are billed to your insurance company.
- Coinsurance: The portion, or percentage, of health care services you are expected to pay. If your coinsurance is 20%, that means you are responsible for 20% of the medical bill and your insurance company picks up the rest, or the 80%.
- Copayment: The out-of-pocket payment you are expected to pay, such as $10 for an office visit.
- Deductible: The amount of money you must pay each year for health care services before your insurer begins to pay some of your bills. Your deductible usually renews every calendar year on January 1.
- EOB or Explanation of Benefits: This is a detailed explanation of what your insurance company will pay for services as outlined in your insurance plan. It is a statement, not a bill.
- Guarantor: The parent or legal guardian who is responsible for a bill.
- Medicaid: A joint federal/state program that provides health care insurance to low-income families.
- Payor: The third-party entity, like your commercial insurance company or a government agency, that pays your medical claims.
- Primary Care Physician (PCP): The physician or pediatrician who provides your child with well child and sick child medical care.
- Prior Authorization: A formal approval, or precertification, from your insurance company sometimes required before certain medical services can be performed. Some insurance companies want to confirm that a service is “medically necessary,” first, and will not pay a claim without this prior authorization.
- Remittance Address: The mailing address where you send your payment for medical goods and services.
- Subscriber: The person who is responsible for your medical insurance policy. Also referred to as the policy holder.
Nemours billing is centralized, which means you only have to make one call for all of your billing and payment questions, no matter where your child received care — at a Nemours hospital, specialty or primary care site — anywhere in the United States.
Contact Nemours Customer Service
Jacksonville, Fla.: (904) 697-3610
Monday–Friday, 8 a.m. to 4 p.m.
When calling about your bill, it’s helpful to:
- Make sure you have your latest bill, which includes your account number and contact information.
- Collect all information (if any) sent by your insurance provider, like an EOB (Explanation of Benefits) or other documents.
- Take notes when you talk to a customer service representative, including the time you called, the name of the person who helped you, and what you talked about.
- Have ready any notes you took from previous calls about your bill.
- Don’t worry — our friendly and knowledgeable customer service representatives are here to help you any way we can.