The billing and payment process related to health care services can be complex and confusing. We want to make it as easy as possible to understand your health care costs at Wake Forest Baptist. We strive to deliver the highest quality of care while ensuring we offer you the financial information required to make informed decisions.
After reviewing the information provided, please contact Customer Service at 336-716-3988 with any additional questions about your financial obligation. Estimating the price of a health care procedure can be complicated. The hospital pricing information provided is what Wake Forest Baptist determines to be the average payment received from private insurance, Medicare and Medicaid. Depending on your health insurance policy, you may be responsible for paying all or part of the allowed amount. These estimates are for hospital services only. Physician services are billed separately.
You can view our pricing for the:
- 100 most common inpatient diagnosis-related groups (DRGs), which are categories for specific medical and hospital services
- 20 most common surgical procedures
- 20 most common imaging procedures
The hospital charges listed are what Wake Forest Baptist determines to be the appropriate cost to treat these 140 DRGs and procedures. The hospital charge is not typically what you have to pay.
Most patients are covered by either private health insurance, Medicare or Medicaid. Private health insurance companies, as well as Medicare and Medicaid, receive what are called allowable reimbursements from Wake Forest Baptist Health. We list these allowable reimbursements for our five largest health insurance companies as well as for Medicare and Medicaid.
If you have health insurance, the allowable reimbursement is what must be paid for treatment. Depending on your health insurance benefit policy, you may be responsible for paying all or part of that allowable reimbursement.
Due to the different physician groups and hospitals within the Wake Forest Baptist system, physician services and hospital services are billed separately. You or your insurance company are also responsible for physician charges.
Include but are not limited to:
- Interpretations of tests
- Surgical procedures
- Consultations performed by physicians and, in some instances, physician assistants and nurse practitioners
Include but are not limited to:
- Radiology and other testing services (referred to as ancillary services)
- Operating room services
- Medical supplies
- Inpatient room and board
- Other services provided by the hospital
Point of Service Payment
Registration and front desk personnel now request up-front payment for patients’ co-pays, coinsurance and deductibles, previous balances, and/or pre-established deposits. Communication to patients prior to service now clearly states this expectation and includes financial assistance counseling where appropriate.
Meeting patient needs will always be our priority. Those who are unable to meet their financial obligations at the time of service may receive information to pursue financial assistance.
Frequently Asked Questions
For a full list of definitions, see the billing glossary. A short list is below:
Deductible– The amount the patient needs to pay for health care services before the health plan begins to pay. The deductible may not apply to all services.
Copay– A fixed amount (for example, $20) the patient pays for a covered health care service, such as a physician office visit or prescription.
Coinsurance– The percentage the patient pays for a covered health service (for example, 20% of the bill). This is based on the allowed amount for the service. You pay coinsurance plus any deductibles you owe.
A patient’s specific health care plan coverage, including the deductible, copay and coinsurance, varies depending on what plan the patient is covered by. Health plans also have pre-arranged networks of hospitals, physicians and other providers that the plan has contracted with. Patients must contact their health plan for this specific information.
If you need an estimate for a specific procedure or operation, please contact the Patient Financial Services area at 336-716-0681.
The estimate will be an average charge for the procedure without complications. Your physician team will determine the specific care needed based on your diagnosis, general health condition and many other factors. For example, one person may require only a one-day hospital stay for a particular procedure, while another may require a two-day stay for the exact same procedure depending on their needs.
Remember that the patient will not pay charges. Patients with health insurance pay only the specified deductible, copay and coinsurance amounts established by their health plan. Patient without health insurance or sufficient financial resources may be eligible for significant discounts on charges. Please contact the Patient Financial Services team for further information.
It is difficult to independently compare charges for a procedure at one facility versus another because the descriptions for a particular service may vary from hospital to hospital, and descriptions may not be comprehensive. An entire procedure includes components from multiple departments — room and board, laboratory, other diagnostics, pharmaceuticals, therapies, etc.
Patients with health insurance need to pay the deductible, copayment and/or coinsurance set by their health plans. Financial obligations may differ depending on whether the hospital or physicians providing service are “out-of-network,” meaning the health plan does not have a contract with them.
A patient without health insurance will discuss with our Financial Counseling Team financial options available that could include the Wake Forest Baptist Health Financial Assistance Program.
Health plans such as Medicare, Medicaid and commercial health insurance do not pay charges. Instead, they pay a set price that has been predetermined or negotiated in advance. The patient only pays the out-of-pocket amounts set by the health plan.
Total Charge– The amount set before any discounts. Hospitals are required by the federal government to utilize uniform charges as the starting point for all bills. The charges are based on the type of care provided and may differ from patient to patient for similar services, depending on any complications or different treatment provided due to the patient’s health.
Cost– For a hospital, it is the total expense incurred to provide the health care. Hospitals have higher costs to provide care than freestanding or retail providers, even for the same type of service.
Total Price– The amount actually paid to a hospital. Hospitals are paid by health plans and/or patients, but the total amount paid is significantly less than the starting charges.
- Medicare and Medicaid pay hospitals according to a set fee schedule depending on the service provided, much less than the hospital charge and actually less than their costs.
- Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges.
Out-of-pocket costs are affected by four factors:
- Overall health of a patient: Patients with underlying health conditions may react differently to treatments and require additional care that increases costs.
- Pre-negotiated insurance carrier rates: Each insurance carrier negotiates the rates at which it will pay Wake Forest Baptist for services provided. Insured patients’ out-of-pocket expenses can vary from one facility to another based on this pre-negotiated rate.
- Insurance benefits: Each insured patient’s out-of-pocket costs will vary depending on the level of benefits he or she chooses as part of their plan.
- Physician practices and preferences: Some physicians order more medical imaging or laboratory testing than others. Wake Forest Baptist encourages patients to talk to their physicians about their general approach to testing.
Files provided below are in compliance with CMS fiscal year 2019 inpatient prospective payment system final rule. (Any pricing information provided on this website is not intended for media use.)
- Wake Forest Baptist Medical Center
- Lexington Medical Medical Center
- Davie Medical Center
- High Point Medical Center
- Wilkes Medical Center
Wake Forest Baptist makes no guarantees regarding the accuracy of the pricing information provided herein. Any pricing information provided by this website is strictly an estimate of prices, and Wake Forest Baptist cannot guarantee the accuracy of any estimates. All estimates are based on information provided by a prospective patient and do not include, among other things, any unforeseen complications, additional tests or procedures, and non-hospital related charges, any of which may increase the ultimate cost of the services provided. Any prospective patient should understand that a final bill for services rendered at Wake Forest Baptist may differ substantially from the information provided by this website, and Wake Forest Baptist shall not be liable for any inaccuracies.