Pre-service Financial Clearance
Our pre-service financial clearance process is designed to help patients understand their financial responsibility before services are rendered. When you request an appointment for health care, a Financial Clearance Representative will complete a pre-service review to confirm that we have accurate billing and insurance information. Our Financial Counselors will work with uninsured patients to find possible insurance coverage, set up interest free payment plans, or offer financial assistance. For insured patients, the financial clearance team will contact your insurance company to verify eligibility, estimate your balance due, and receive pre-certification and authorization for your upcoming visit.
If you believe you have an emergency medical condition and request services in one of our emergency departments, you will receive appropriate emergency medical care regardless of your ability to pay.
Before non-emergency services are delivered or after emergency conditions have been stabilized, a financial service representative will:
- Validate and protect your patient identity – To protect your medical and financial information, we use commercially available data sources to validate the accuracy of your name and address. To receive non-emergency services, you will be asked to provide a photo ID, and we will include a copy of your photo ID with your medical record.
- Verify health insurance benefits – To minimize your costs, we collect your health insurance information and verify your eligibility and benefits with your insurance company. If you don’t provide insurance information, we check with major health insurance companies and the North Carolina Medicaid program to see if you have eligible coverage.
- Verify medical necessity – To accurately communicate costs for services that are not covered by your health insurance, we verify the medical diagnosis and procedure codes so you can make an informed decision about receiving the recommended services.
- Obtain prior authorizations – If your health insurance company requires prior authorization for the services you are to receive, we try to get that authorization for you. You are still responsible for confirming your health insurance benefits and coverage. If we are unable to get prior authorization, you are responsible for the cost of services you receive.
- Identify open bad debt accounts – If you have previously unpaid accounts with us and you are not enrolled in a payment plan, those balances must be paid in full or you must set up a payment plan before you can receive non-emergency services.
- Provide an estimate of service costs – We estimate your out-of-pocket expenses based on your health insurance benefits, your health insurance company’s prior authorization requirements and any open prior balance accounts.
- Identify available third-party programs – If you do not have insurance, we check to see if you qualify for any private health insurance or publicly sponsored programs. You can also check for this by visiting www.CoverageForAll.org.
- Provide enrollment assistance – If you qualify for one or more third-party programs, you must enroll in the program(s) to receive non-emergency services at Wake Forest Baptist. A financial service representative will help you apply for these benefits.
- Screen for financial assistance – If you do not qualify for a third-party program, we check commercially available financial data about you to see if you qualify for financial assistance discounts through Wake Forest Baptist. We only access these data as part of our financial clearance process.
- Provide COBRA assistance – If you are eligible for COBRA coverage through a previous employer, Wake Forest Baptist may be able to help pay the costs of enrolling in the private health insurance plan. This is determined on a case-by-case basis.
- Provide interest free payment options – If you need help paying your medical bills over a longer period of time, Wake Forest Baptist offers patients a 0% interest free loan program through Commerce Bank. No credit checks are required to enroll, only identity verification.
- Our pre-service financial clearance process includes a consultation with our Financial Clearance Representative who will talk with you or your financially responsible party about your deductible and out-of-pocket expenses. Minimum deposits are required before you receive non-emergency services, and payment arrangements must be made prior to discharge.
- Wake Forest Baptist’s care delivery relationship is between you (the patient), your doctor and our hospitals. Our clinicians develop treatment plans in consultation with you. When you sign the “Consent to Treat” form, you accept the treatment plan and the responsibility to pay the costs for those services.
- Wake Forest Baptist bills for services according to guidelines established by the American Medical Association and/or Centers for Medicare and Medicaid Services.
- If a third-party payer denies payment for services you have received, we seek payment directly from you (the patient), unless otherwise prohibited by state or federal regulations.
- If you disagree with how a service was billed or how insurance benefits were applied, our Customer Service team will review your bill, help prepare an appeal and involve the appropriate regulatory agencies.
- Financial assistance is available for those who qualify. Learn more about financial assistance.
- Wake Forest Baptist sends out monthly billing statement(s) that list both physician and hospital charges.
- On billing statements, we identify each individual of a household who has received services and any respective charges.
- If you have provided us health insurance information, we bill after your insurance has processed your claim.
- We send four patient statements 30 days apart. Each statement provides the opportunity to pay the balance in full or pay the balance through an interest-free payment plan.
- You must contact us to set up a payment plan for your patient balances (any amount you owe). If you have an unpaid patient balance older than 120 days from initial billing, you must enroll in a payment plan in order for your account not to be sent to a collection agency.
- The Customer Service Center can answer questions about your bill and help you understand our financial policies and billing procedures. Call: 336-716-3988 or 877-938-7497, Monday through Friday from 8 am to 5 pm.
Point of Service Payment
We collect the amount the patient is responsible for before or at the time of service. Our registration and front desk staff will request payment for co-pays, coinsurance and deductibles, previous balances, and/or pre-established deposits.
Meeting patient needs is always our priority. If you are unable to make your payment, please ask about payment options or financial assistance when you arrive for your visit or by calling our Financial Counseling department (336-716-0681) prior to your visit.
After your health insurance company has paid its portion of your visit, we will send you monthly statement(s) for the amount that you owe.
We will contact you at least four times (via billing statements, phone calls and e-mails) during a 120-day period to remind you of your balance. During this period, you will be expected to pay your balance in full, set up a payment plan or apply for financial assistance.
If the balance is unpaid after the 120-day billing period, your account will be sent to a collection agency. If the balance is not paid or set up on a payment plan within 60 days of collection agency placement, your credit score may be impacted and future appointments or non-emergency services may be delayed or canceled. If a balance is not eligible for any form of assistance and there are not available assets to satisfy the balance owed, Wake Forest Baptist may obtain an attorney to assist with collection efforts.
View our Billing and Collections Policy.