Our patient-friendly billing and financial services team at M Health Fairview Pediatrics is here to make billing and insurance easy for the families we serve. Here, we’ve pulled together answers to some of the most common questions and topics about billing.
Common Billing Topics
Hospital Outpatient Departments
If your child received care as an outpatient at one of our hospitals, including at a pediatric specialty clinic, emergency room or other department, you can expect to get a separate bill for each service and from each provider who treated your child. For example, if you received surgical care in one of our facilities, you may get separate bills for anesthesia, the surgeon, radiology, lab, and pharmacy. Your bills will include:
- A facility bill from M Health Fairview to cover hospital expenses
- One or more professional bills from the doctor or medical care team that treated you
Freestanding Clinics
A “freestanding” clinic is a doctor’s office or other healthcare site that is not part of a hospital or hospital-based location.
If your child gets care in one of our many M Health Fairview Pediatrics freestanding clinics, you’ll get just one bill from M Health Fairview Pediatrics. The bill will include provider charges as well as any lab work, scans, X-rays, or other tests your child received. Typically, the cost of getting care at a freestanding clinic is lower than it would be if your child were treated at the hospital.
There are times when you’ll still get more than one bill after visiting a freestanding clinic. This can happen when your doctor sends a lab culture or biopsy to another lab for testing. The doctor usually sends your insurance information along with the lab work, and the lab bills your insurance provider directly. But sometimes the lab bill will come to you. If this happens, and you have health insurance, check with your insurance company before paying the lab bill.
All Patients
You may need to prepay for part of your child’s care. When you register, we collect copayments, coinsurance, unmet deductibles, and other charges that insurance won’t cover. To plan for this, call the customer service number on the back of your health insurance card. Ask them if you will have a copayment, coinsurance, or unmet deductible for your upcoming visit. Your insurer can also tell you what your specific health plan does and does not cover. This will help you plan for the cost of your child’s care.
To avoid surprises about costs for your child’s care, check with your health insurance company before your child’s appointment or procedure to find out whether the M Health Fairview Pediatrics provider or location you plan to visit is in your health plan’s network. You can do this by calling the member services phone number on your health insurance card or by logging in to your health plan’s website, which should be listed on your insurance card as well.
It’s also a good idea to talk with your insurance company’s member services representative about your rights and responsibilities, including whether you need a referral or prior authorization (permission) for your child’s appointment.
M Health Fairview Pediatrics providers are in-network on many insurance plans. Review our list of accepted health plans.
You have the right to an estimate of the charges for your child’s care. You also may speak to a financial counselor before you agree to a suggested procedure. There are three different ways to obtain an estimate for the cost of care:
- Request an estimate through M Health Fairview’s mobile app or MyChart. If you don't have a MyChart account, click the "sign up now" link on the page to get started.
- View our online patient cost estimate tool.
- Submit a pricing inquiry request form.
If you have additional questions, you can call our cost of care/estimates team at 612-672-1048, 8 a.m. to 3 p.m. Monday through Thursday, and 9 a.m. to 3 p.m. on Friday. You can also view hospital pricing and compare charges on the Minnesota Hospital Association website.
The U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services also requires hospitals and health systems to disclose all standard charges. Negotiated rate and gross charge information is available here, listed by hospital:
- M Health Fairview Lakes Medical Center
- M Health Fairview Northland Medical
- M Health Fairview Ridges Hospital
- M Health Fairview Southdale Hospital
- M Health Fairview St. John’s Hospital
- M Health Fairview Masonic Children’s Hospital
- M Health Fairview University of Minnesota Medical Center
- M Health Fairview Woodwinds Hospital
- M Health Fairview Bethesda Hospital (LTAC)
Minnesota statute 62J.812 requires our primary care clinics to post charges and payments for 25 of the most commonly billed procedures and the average payments or reimbursements received for those services from government and commercial insurance. You can review this information here:
- M Health Fairview Clinics, formally known as Fairview Clinics
- M Health Fairview Clinics in the east region, formerly known as HealthEast
Prices listed do not reflect what you may owe for your child’s care. The amount you may owe out of pocket for your child’s care depends on the type of insurance you have and your insurance’s contracted rate with our children’s health system.
If you would like to get an accurate estimate of the payment rate M Health Fairview Pediatrics will receive related to your child’s care and/or an estimate of what you may need to pay out of pocket, please contact your health insurance company.
The No Surprises Act is designed to protect individuals and families from receiving surprise medical bills.
Learn more about your rights and protections against surprise medical bills. Information is also available in Amharic, Arabic, Chinese, Hmong, Karen, Oromo, Spanish, Somali, Russian, and Vietnamese.
If you are uninsured or self-pay, learn more about your right to a good faith estimate. Information is also available in Amharic, Arabic, Chinese, Hmong, Karen, Oromo, Spanish, Somali, Russian, and Vietnamese.
If you need help paying your child’s medical bills, there are options available. We can help with flexible payment plans, financial assistance, and more. To explore your options, call the appropriate customer service helpline listed below and ask to speak with a financial counselor.
M Health Fairview
8 a.m. to 5:30 p.m., Monday through Thursday
9 a.m. to 4:30 p.m., Friday
M Physicians
8 a.m. to 4:30 p.m., Monday through Friday
Out-of-Pocket Cost Topics
Your bills depend on the clinics or hospitals your child visited, and the healthcare services your child received. A portion – or all – of your cost may be covered by your insurance. Or you may be required to pay out-of-pocket costs, like a deductible, co-insurance, or a co-payment. If that’s the case, your out-of-pocket cost may be different depending on whether your child received care in a freestanding or hospital-based clinic.
For more information on hospital-based clinic, please click here.
A hospital-based clinic is owned and operated by a hospital, though it may not be situated within the main hospital building. A freestanding clinic is a doctor’s office or other healthcare site that is not part of a hospital or hospital-based location and is not owned or operated by a hospital. Some of M Health Fairview’s pediatric specialty clinics are hospital based, but many of our primary care clinics are not.
Because of differences in the way many insurance companies structure their coverage, a visit to a pediatric hospital-based clinic may cost more out of pocket than a visit at a pediatric freestanding clinic. For example, copay, coinsurance, or deductible amounts may be higher. Your insurance company can explain the cost difference between services your child received in a hospital-based clinic and those your child received in a freestanding clinic.
Before your visit, it’s a good idea to check with your insurance company to learn about your insurance coverage, referral requirements, and payment options. Be sure to ask about the cost difference in facilities designated as "hospital-based-outpatient" or "provider-based." These locations are sometimes referred to as "hospital outpatient place of service." There may be exceptions for specific programs or services within a clinic or for imaging or anesthesiology services.
If your insurance does cover facility charges in these places, consider asking:
How much of the facility charge is covered?
What will my out-of-pocked costs be, including how they contribute to my deductible?
What is my co-pay for visits or treatments at these facilities?
For more information on hospital-based clinic, please click here.
M Health Fairview’s hospital-based pediatric clinics include:
- Lions Hearing and Ear, Nose, and Throat Clinic
- M Health Fairview Center for Bleeding and Clotting Disorders
- M Health Fairview Katie Hageboeck Children’s Cancer Research Fund Clinic (formerly Journey Clinic)
- M Health Fairview Pediatric Specialty Clinic - Discovery
- M Health Fairview Pediatric Specialty Clinic - Explorer
- M Health Fairview Pediatric Specialty Clinic – Burnsville
- Minnesota Lions Children’s Eye Clinic
As a first step, it’s a good idea to find out what your insurance provider’s health plan does and does not cover. Any charges your health plan doesn’t cover are your responsibility to pay. Payment is due within 30 days of when you received your statement in the mail.
To pay your balance, we have four convenient options for you:
- Online: You may pay your bill and view your account summary in your MyChart account. If you do not have an account, sign up for one here.
- By phone: You can pay by phone using a debit or credit card. Call the phone number on your bill to make a payment.
- By mail: You can mail in your payment with the statement.
- In person: You can make a payment in person at the hospital or clinic where your child received care.
If you want to set up a payment plan or combine payments, you can get started by logging into your MyChart account or calling the number on your bill.
If your insurance plan requires a copay, it’s due at your child’s visit. We accept cash, personal check, and credit/debit cards (Visa®, MasterCard®, American Express®, and Discover®).
Ask a Question About Your Bill
If you reviewed the information above and still need help understanding your bill, our financial counselors can help. Call us at the numbers listed below for answers about your bill, to discuss possible costs and insurance coverage, or to review payment and financial assistance options that may be available to your family.
M Health Fairview
M Physicians
Paperless Billing Topics
Starting May 9, 2022, M Health Fairview Pediatrics patients with active MyChart accounts will receive billing statements electronically via MyChart instead of receiving hard copies via U.S. mail. When a bill is ready for you to review, you will be contacted based on the preferred contact method designated in your MyChart communication preferences.
Yes. If you’d prefer to keep receiving paper statements, log in to MyChart or the M Health Fairview mobile app to switch your default delivery method back to U.S. mail. If you need assistance, call 1-855-324-7843.
You will receive a courtesy call as a reminder of your outstanding balance.
M Health Fairview contracts with outside groups to provide certain services, including anesthesia, emergency room care, and radiology. Because these providers are outside M Health Fairview, they are not included in M Health Fairview’s paperless billing. You will continue to receive paper statements for these outside services unless you make arrangements with those companies directly.
If your children are under 18 and you are responsible for their accounts, you will receive their statements through MyChart. Anyone 18 and older will receive their statements in their MyChart account directly unless someone else is designated as their legal guardian.
If you previously opted out of paperless billing, you will continue to receive paper bills. You won’t be switched to paperless billing unless you tell us you want to do so.