Price Transparency and Cost Disclosure

Children’s National is a hospital-based service provider. Provider visits include facility fees. The facility fees include costs for running the facility, such as supplies, equipment, exam rooms, educational resources, counseling and staff. It is separate from the cost of the medical provider.

Fees are determined based on the type of visit and the resources used during your visit. The exact facility fees cannot be calculated until after the medical services have been provided and your visit is finished.

Insurance Coverage of Facility Fees

Medicaid plans cover the full clinic facility fees. 

Commercial insurance plans may apply different benefits to outpatient clinic facility fees. This may change the out-of-pocket expense; for example, patients/families may be responsible for annual deductible requirements, co-insurance or co-pay amounts.

Financial Assistance maybe provided for income eligible families to cover up to 100% of out-of-pocket expense.

When you see a doctor or other healthcare provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” or “balance billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care — like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

We encourage you to work with your insurance company to ensure you are accessing your highest level of benefits by using your in-network benefits. If you choose to use your out-of-network benefits for non-emergency services, you will be required to sign an additional consent.

• You are only responsible for paying your share of the cost (like the copayments, coinsurance and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

Virginia law prohibits out-of-network providers at in-network facilities from balance billing patients for emergency services at a hospital and certain non-emergency services. Virginia’s law applies to Virginia-regulated managed care plans, plans purchased on Healthcare.gov, and state employee benefit plans. 

Maryland law prohibits out-of-network providers from billing enrollees for amounts beyond in-network level of cost sharing. Maryland’s law applies to emergency services provided by out-of-network professionals, facilities and ambulance providers. Maryland’s law also applies to non-emergency services provided by out-of-network professionals at in-network facilities. 

Emergency Services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance).

Certain Services at an In-network Facility

Even when you get services from an in-network facility, certain providers within that facility may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. Those providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

Families can use this tool to enter insurance information and look up the estimated costs for appointments and medical procedures.

Good Faith Estimates

In accordance with the No Surprises Act, Children’s National can provide a Good Faith Estimate for scheduled visits for uninsured/self-pay patients or upon request. 

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.

You can request a Good Faith Estimate before your scheduled item or service. Please submit your request in writing at least three days in advance of the medical item or service. 

If you receive a bill that is at least $400 more than your Good Faith Estimate for the services identified in the request, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate.

You can also view information about HSC services and charges. (CSV)

In situations where a patient does not have insurance, our hospital has financial assistance policies that apply discounts to the amounts charged. For more information about the cost of your care, please contact your insurance company or our patient financial services staff.

If you believe you’ve been wrongly billed, you may contact your local government responsible for enforcing the federal and/or state balance or surprise billing protection laws. Visit https://www.cms.gov/nosurprises for more information about your rights under federal law or call 800-985-3059.

To request a Good Faith Estimate please contact customer service Monday through Friday, 9 a.m. to 4 p.m. toll free at 800-787-0021 or by email.