Paying for Your Care
Health care billing and payment can be complex and confusing -- but it doesn't have to be. Here are some tips to help you prepare for paying for your care.
Before Scheduling Your Hospital or Clinic Visit
Before the day of your appointment, there are a few steps you need to take to help avoid surprises.
Check with your health plan or employer to understand:
- What your access and insurance coverage amounts are for receiving health care services at Duke.
- What deductible, copayment, or coinsurance amounts you may owe after treatment.
- If your estimated payment due will be greater than $250.
- If you need prior authorization for elective services.
- If you are required to notify your primary care physician to obtain a referral to see us.
- If and what you will be required to pay at the time of service (if your health plan decides that your service was not medically necessary, is a pre‐existing condition, or is not a covered service).
- To speed up your check‐in process, you may pay your estimated balance due prior to your date of service.
Be sure to review our list of specific health plans accepted by Duke Health. This page includes information on health insurance plans, national transplant networks, and Medicare Advantage. We make every effort to keep this information current. However, it is subject to change at any time without notice.
Bring your complete health insurance information when you register including:
- All insurance cards
- Authorization forms
You may be asked to sign some forms, such as a release of information, depending on your visit.
You may be interested in what your services will cost. You have the right to know the fees and to receive counseling on the availability of resources to help you pay for your health care. Duke University Health System supports price transparency and stands ready to provide information in a variety of ways:
- State-wide hospital pricing and payment data for common procedures
- Price estimates for unscheduled procedures
- Price and “out-of-pocket” estimates for scheduled procedures (includes professional fees)
In addition to the support outlined below, the following resources are available to help consumers understand healthcare prices:
The North Carolina Department of Health and Human Services receives charge and payment information reported by hospitals and ambulatory surgical centers for certain common inpatient and outpatient services. You can search their website to find average charge information for common procedures performed at hospitals in North Carolina.
A DRG (Diagnostic Related Group) number or CPT (Current Procedural Terminology) will narrow the search. These codes may be obtained from your treating physician(s). The average charge is the amount that will be charged to a patient if all charges are paid in full without a public or private third-party paying for any portion of the charges or without any applicable discounts applied. Average charge information may not be helpful in determining patient out of pocket expenses which requires a knowledge of insurance benefits and applicable insurance discounts.
Pre-visit Estimates for Unscheduled Services
Financial counselors are available to assist you with average charge information or pre-service estimates. Please call 919-620-3264 for assistance. Both the charge information and pre-service estimates are based on averages and may deviate significantly from the minimum and maximum values. Actual charges will be based on actual services rendered.
Pre-visit Estimates for Scheduled Services
For scheduled procedures at the following locations which tend to cost slightly more out-of-pocket, our Pre-visit Estimate team will estimate how much you will owe after insurance:
- Duke Radiology
- Ambulatory Surgery Center
- Duke Hospital operating room
- Duke Hospital admissions
- Duke Regional Hospital admissions
- Duke Regional outpatient surgery
- For these services, one of our skilled financial counselors will call you prior to service and provide an estimate of your out of pocket expense. The financial counselors will:
- Provide an estimate of your liability after insurance
- Assist you with payment options
- Facilitate payment at the time of service when preferred.
During Your Hospital or Clinic Visit
Inform us of any changes with your information including:
Information that is not current can cause payment delays or denials that may ultimately leave you responsible for paying the balance.
Expect required payments such as:
- Previous balances
- Co‐payments for both physician and hospital care
- Estimated coinsurance or deductibles as required by your health plan
- Deposits or full payment for certain services not covered by insurance
The person who consents to medical treatment, including the legal guardian of a child, will be financially responsible for the bill.
You will be asked a series of questions required by law at each visit regarding:
- Your status, including other insurance you may have
- Your retirement date
If you are covered by Medicare, we will submit your claims to Medicare on your behalf.
You must sign a notice that holds you financially responsible for the services we provide to you. This is just in case Medicare deems the services not medically necessary and does not cover the services.
After Your Hospital or Clinic Visit
Pay your bill in one of four ways:
- Online using a MyChart account
- By mail with check or credit card, within 15 days after receipt of statement, following the instructions on the statement
- By cash at the time of service or as a walk-in to the Customer Service Department located at 5213 South Alston Avenue, Durham, NC 27713
- Apply for financial assistance if applicable
- Expect a bill to you and/or your supplemental insurance carrier for services not covered by Medicare, such as medications you give yourself and routine health exams.
- Expect to pay if Medicare or your supplemental insurance does not cover the services that we provided.
Amounts Generally Billed
Patients who do not have insurance or other third party coverage will get a discount on their bill equal to the best discounts offered to insurance companies. This discount is automatically applied to your bill, and Duke Health uses the Look Back method to calculate this discount. For more information on how to obtain the current discount percentage and how it was calculated, please submit a request in writing to “Self Pay Collections, 5213 S Alston Ave, Durham, NC 27713”.
We will send you monthly bills for any unpaid balances for up to 120 days after treatment. During this 120-day period, we will contact you four times via statements, phone calls, and/or e‐mails to remind you about your unpaid balance. During this period, you are expected to either:
- Apply for financial assistance
- Establish an interest-free payment plan
- Pay your bill in full
- After the 120-day period, if you do not take one of the three actions listed above, then your account will be sent to a collection agency. Your credit report may reflect the unpaid bill 60 days after collection agency placement.
In select cases, Duke University Health System may choose to engage an attorney to collect payment.
This step would occur only after Duke University Health System has thoroughly reviewed the account and determined that you are not eligible for financial assistance or other forms of coverage.
All patients have the right to receive an itemized statement that provides details of the charges related to their visit upon request. Itemized statements can be obtained by calling customer service.
All patients have the right to dispute their charges and to have their bill reviewed to ensure that the charges are accurate and supported by the medical record. Patients may request this review by calling customer service or sending a request in writing to the address listed on their statement. At the conclusion of this review, any necessary corrections will be made and findings will be communicated to the patient.
Patients have the right to appeal if a bill is reviewed and the billing is found to be accurate. Patients may request an appeal in writing to the address listed on their statement or by calling the customer service.
Patient overpayments that are identified will be refunded to the patient within 30 business days. Patients that wish to expedite their refund can call customer service.
If you have a question about your bill, contact our Customer Service Center at 919-620-4555 or 800-782-6945 Monday through Friday, 8:00 am to 5:00 pm. Request to speak with a Patient Account Representative.