As a courtesy to our patients, UPMC bills the insurance carrier directly for most services. Co-pays, deposits, and other co-insurance amounts are due at the time the services are provided. Depending on your insurance, you may be responsible for paying the entire charge and any charges for services not covered by your insurance. For a list of services that are not covered, please contact your insurance company.
Any additional patient financial responsibility is due when you receive your medical bill. You may receive more than one bill for services rendered at UPMC. These bills may be from a hospital, physician, or an ambulance service.
If you receive a hospital bill and do not understand the content, or if you believe that the information may be incorrect, please call our Customer Service Department at 412-432-5500 or toll-free 1-800-854-1745. If you would like to request information about a UPMC physician bill, please call 412-442-9600 or toll-free 1-888-647-9600.
Insurance Referrals and Authorizations
Based on your insurance coverage and the medical services provided, an authorization or referral from your insurance carrier may be required. It is important that you are familiar with your benefits and the extent of your medical coverage. We suggest that you contact your insurance carrier before scheduling a procedure. Also, please check with the registration clerk or your insurance carrier to find out if a referral or authorization is needed for your procedure
Hospital Based Clinics
UPMC is designated as a hospital-based-clinic. A hospital-based-clinic is a facility similar to a physician’s office. The clinic provides diagnostic, preventive, curative, and rehabilitation services. The services are provided by an employed physician; however, the clinic is owned and operated by the hospital. Some insurance companies view this type of service as an outpatient clinic visit. You may incur a facility charge that may be assigned as patient’s responsibility. This kind of charge may not typically be incurred if the clinic were not considered hospital-based.
The physician’s bill is for professional services or procedures performed by your personal doctor. The hospital bill or the facility bill covers the cost of the operating room and other overhead costs.
Under Centers for Medicare and Medicaid Services (CMS) regulations and insurance industry regulations, UPMC sends bills for both the facility and professional services. The insurance carrier has different requirements based on the contract with the health care provider. Depending on your insurance plan, you may be responsible for paying the entire hospital or facility bill, co-insurance, and/or related co-pay for physician charges. You will receive separate bills from the physician and hospital for both inpatient and outpatient visits.