The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid.

The total amount a provider expects to be paid by payers and patients for healthcare services.

The definition of cost varies by the party incurring the expense:

• To the patient, cost is the amount payable out of pocket for healthcare services.
• To the provider, cost is the expense (direct and indirect) incurred to deliver healthcare services to patients.
• To the insurer, cost is the amount payable to the provider (or reimbursable to the patient) for services rendered.
• To the employer, cost is the expense related to providing health benefits (premiums or claims paid).

The amount you must pay for medical treatment before your health insurance provider starts to pay. For example, it might be $1,000 per individual or $3,000 per family. In most cases, a new deductible must be reached each year before insurance will begin paying.

The part of your bill that you must pay, often in addition to a copay. Coinsurance is usually a percentage of the total medical bill.

A copayment, or copay, is the part of your medical bill you must pay each time you visit the physician. This is a preset fee determined by your health insurance provider.

These are costs for medical treatment that your insurance provider doesn’t pay. It’s your responsibility to determine if treatment is covered by your health insurance provider before being billed.

You may be asked to pre-pay for services. If pre-payment is not requested before services are rendered or the charges for a service are more than the pre-payment amount, you’ll receive a bill shortly after the services are provided requesting payment for the balance due. If you’d like, you can learn about financial assistance options or contact a counselor at 570-214-4112.

You can purchase health insurance from Pennsylvania’s health insurance marketplace. Geisinger has certified application counselors trained in the health insurance marketplace, as well as in Pennsylvania's Medical Assistance (Medicaid) program. Our counselors can assist you in applying for and obtaining insurance prior to service.

Need help? Call 855-849-1510 to speak with or to schedule a face-to-face appointment with a Geisinger Trusted Advisor. This service is offered free of charge.

To see if Geisinger is considered participating as an in-network provider with your insurance plan, you can do any of the following:

• Consult the provider directory given to you by your insurance company
• Check your insurance company's website
• Call your insurance company's customer service department,
• Review our accepted insurance plans.

You can share or update your health insurance information with Geisinger in one of the following ways:

• Option 1: Call 800-640-4206.
• Option 2: Update your insurance in person at any Geisinger hospital or clinic.

You can contact your insurance company for information about benefit coverage before getting care.

After you receive services, Geisinger will file insurance claims on your behalf. You’re responsible for payment of any remaining balance after insurance. Note that some payments are due before or at the time you receive care.

You’ll receive a bill for any remaining balances determined by your insurance provider. If you’d like an estimate of your cost-sharing responsibilities, you can use Geisinger’s free cost estimator tool. To review and arrange payment options, you can contact us in either of the following ways:

• Call 800-640-4206.
• Set up an in-person appointment with a financial counselor by calling 570-214-4112.

Your Geisinger doctor will decide which procedures, tests and other consultations you may need. Many health plans require precertification before care is rendered. Some services may not be a covered benefit with some health insurance plans.

Don’t know if precertification is necessary? Contact your insurance company’s customer service department. Geisinger will coordinate obtaining authorization with you and your insurance company, as your insurance company may request specific clinical information from the provider before they’ll authorize a service.

To check the status of your authorization, call Geisinger MyVisit at 866-521-5179.

Contact your insurance company for complete details about the denial. You may be able to appeal it. Your insurance company determines specific appeal processes and timelines. If you need more information or help, call our Patient Service Call Center at 800-640-4206.

If you’ve already contacted your insurance company and they tell you they’ll be reprocessing your claim, ask for a reference number. Then call our Patient Service Call Center at 800-640-4206 for further help.