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 based on an average amount billed to patients that have had this service at our facility over a period of time. Depending on your health insurance policy, you may be responsible for paying all or part of the allowed amount.
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.
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.
You or your insurance company may be responsible for both Physician and Hospital Services.
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.
Get an Estimate for a Procedure
If you need an estimate for a specific procedure or operation, Wake Forest Baptist Health has a user-friendly tool that can estimate your out-of-pocket costs for some common procedures, including imaging and labs. Please click here to access the online estimator tool.
If your procedure isn't one of those listed on the online estimator tool you can contact Patient Financial Services at 336-716-9391.
Remember that the patient will not pay full charges. Patients with health insurance pay on the specified deductible, copay and coinsurance amounts established by their health plan. Patients 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.
The online estimator tool is part of myWakeHealth (MyChart), our free online patient portal. Learn more about how you can sign up for myWakeHealth, or you can use the estimator tool as a guest.
Your Right to Receive a "Good Faith Estimate"
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- 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.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
Your Rights and Protections Against Surprise Medical Bills
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care 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 health care 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” 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.
You are protected from balance billing for:
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). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These 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.
When balance billing isn’t allowed, you also have the following protections:
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.
Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
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.
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 the CMS Hospital Price Transparency rules effective January 2021 and only include the hospital facility pricing information specific to each facility. (Any pricing information provided on this website is not intended for media use.)
- Wake Forest Baptist Medical Center
- Lexington 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.