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Billing and Insurance

You should be able to focus completely on your health without worrying about costs.

Our team is here to answer any billing and insurance questions you might have upfront, so there is never any confusion. On this page, you’ll find helpful information about insurance, fees, billing and assistance in the following sections:

Understanding your health insurance

Does Valleywise Health take my insurance?

Obamacare/Marketplace Plans 2019

Understanding your bill

Can I get financial assistance?

Using Valleywise Health direct pricing

What are Arizona’s poverty guidelines?

Good Faith Estimate

Uninsured patients or patients not using their health in­surance have the right to receive a “Good Faith Estimate” explaining how much medical care for a service will cost.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (602) 344-1866.

Understanding your health insurance

The best way to ensure a smooth payment process is to understand what your insurance plan allows and what it charges for before you get treatment. We’re always here to offer guidance and answer any questions you might have, but we recommend following this checklist before scheduling your services with us:

1. Make sure we accept your insurance plan

For a list of insurance plans we accept, take a look at the following section (Does Valleywise Health take my insurance?) If you don’t see your plan, call your insurance company and ask if they consider Valleywise Health to be in-network.

2. Find out if your plan requires a referral or authorization

Depending on the nature of your visit, your insurance plan may require a referral or authorization in order to schedule your procedure or specialist visit. Call your insurance company to check on this. If they do require a referral, call your primary doctor first to get it, and then make your appointment with us.

3. Make sure we have your family’s up-to-date health insurance information

Giving us the most accurate information ensures that we can accurately answer your insurance questions.

4. Learn more about the fee for your visit

Call our Eligibility Specialist at (602) 344-2550 and ask what the fee for a physician’s office visit will be. Your total fee will depend on what specific services you might need. Since we can’t always determine what these services will be ahead of time, we may not be able to provide a complete cost estimate in advance (though we will certainly try our best to give you an answer).

If you have a hospital stay, these are the things that will be included in your total cost:

  • The physician’s time spent examining you
  • Any procedures or tests we perform
  • Services including nursing care, supplies, medical machines and equipment and the use of the hospital’s facilities

5. Find out about the services covered by your insurance plan

Most insurance plans ask you to pay a co-pay, deductible or co-insurance. Your plan may also pay differently for certain services (such as labs and radiology) or certain Valleywise Health locations, which may affect what you owe.

All of these amounts are set by your insurance plan. Call your insurance company directly for more information.

6. Be prepared to pay your co-pay or co-insurance at the time of your visit.

If you need to make a payment for your visit, you can pay with:

  • Cash
  • Check
  • Credit card

If you’re not able to pay your co-pay at the time of your visit, our staff will send you a separate bill for it.

Remember, you can always call us with any questions or concerns you might have. Call Customer Service at (602) 344-8181.

Does Valleywise Health take my insurance?

We’ve made it simple to figure out whether or not we accept your insurance. Take a look at the following list to see if your insurance plan has an agreement with us.

For the most part, we accept many major commercial, Medicaid and Medicare insurances. Our agreement with each is different, so the services and costs covered vary based on your insurance provider. Just give your insurance company a call to learn more about what’s covered – your membership card has the number to contact their customer service line.

As part of our commitment to making sure you’re always receiving the best possible care, we want your physician to have easy access to your test results, prescriptions or other doctor’s notes. This makes it easier for your doctors to share important information, prevent medical errors and give you the fast and efficient treatment you need. As a participating provider with the Arizona Care Network, we work together with your insurance company to make sure of this.

Questions? We can help. Call our Eligibility Specialists at (602) 344-2550.

Valleywise Health Insurance List

Understanding your bill

We want to help break down your bill and keep it simple for you. Your total bill will consist of a couple of primary costs: insurance plan-specific costs and our Valleywise Health costs.

Your insurance plan should cover the majority of your visit – however, you’ll still need to pay any co-pays, co-insurance and deductibles that your insurance plan might require.

We will only bill you for the use of our facility and physician-specific costs.

Facility bill (hospital or clinic)

The facility charge covers the cost of running the facility and can include supplies, equipment, radiology, laboratory services, exam rooms, non-physician staff, and other costs. The amount you pay depends on the type of visit and the resources used to treat you and what your insurance covers.

Physician bill

The physicians, radiologist and other specialists may bill you from their practice for their professional services. This includes providers at Valleywise Health’s Roosevelt Campus and all Primary Care and Specialty Care locations.

Questions about your bill? We’re happy to provide more details. Call (602) 344-8181.

Can I get financial assistance?

Nothing should stand in the way of you getting the treatment you need – especially not finances. We offer a couple of options for financial assistance and coverage options to best suit your needs.

AHCCCS

AHCCCS is Arizona’s Medicaid agency that offers a number of health care programs to meet your needs. If you have limited income and need insurance coverage, you may qualify for AHCCCS coverage. Our team is here to help you apply for it.

To learn more and apply, call our Eligibility Specialists at (602) 344-2550 to schedule an appointment at any Health Center nearest you.

Valleywise Health’s Financial Assistance Program

If your insurance doesn’t cover all your medical costs and you can’t afford to pay your bill, don’t stress – our team can help you apply for the Valleywise Health Financial Assistance Program. Here is some important information:

  • To participate, you must have applied for AHCCCS coverage and been denied.
  • The program uses a sliding fee scale to determine what you pay based on your income level and household size.

Sliding Fee Discount Schedule

What documents do I need to bring to my appointment?

  • Identification: Current I.D. or birth certificate for every person in your household.
  • Proof of Income: Information that verifies income for the last 30 days or a statement from the person(s) providing you financial support.
  • Proof of Address:  Verification of your residency. It can be a recent utility bill, rent or mortgage receipt, voter registration card or a letter from a non-related landlord or neighbor.

Questions? Please contact our Eligibility Specialists at (602) 344-2550.

Using Valleywise Health direct pricing

Not sure whether you’d like to pay for a medical procedure out-of-pocket? Check out the following guides to help you understand your options and make the best decision for you and/or your family.Below you can find the average discounted self-pay prices for the most common procedures done at Valleywise Health. No two patients or procedures are exactly alike, so the actual price may be different depending on a number of factors, including pre-existing conditions, how long the procedure takes, complications, length of hospital stay, involvement of specialists, and more. In the documents below you can also find Valleywise Health standard charges. These self-pay prices listed are reduced and represent the out-of-pocket responsibility of uninsured patients based on family size and income as it relates to the Federal Poverty Level. Patients with commercial, Medicare or AHCCCS coverage are responsible for out of pocket amounts determined by their insurance company.

What are Arizona's poverty guidelines?

The table below shows the amount of income that you or your family/household would have to make in order to be considered “impoverished.” If you or your family meet the state’s poverty guidelines, you can receive more financial assistance for medical care. Again, your health is the most important thing to us, and we never want an inability to pay to stop you from getting the care you need. We’re always happy to help, so please review the chart and contact us if you have any questions.

# of people in family/household
Poverty guideline

1

$12,760

2

$17,240

3

$21,720

4

$26,200

5

$30,680

6

$35,160

7

$39,640

8

$44,120

Please note that if your family/household has more than eight people, you’ll need to add $4,420 for each additional person.

Learn More

Billing and Insurance

You should be able to focus completely on your health without worrying about costs.

Our team is here to answer any billing and insurance questions you might have upfront, so there is never any confusion. On this page, you’ll find helpful information about insurance, fees, billing and assistance in the following sections:

Understanding your health insurance

Does Valleywise Health take my insurance?

Obamacare/Marketplace Plans 2019

Understanding your bill

Can I get financial assistance?

Using Valleywise Health direct pricing

What are Arizona’s poverty guidelines?

Here are some things to bring with you:

Uninsured patients or patients not using their health in­surance have the right to receive a “Good Faith Estimate” explaining how much medical care for a service will cost.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (602) 344-1866.

Understanding your health insurance

The best way to ensure a smooth payment process is to understand what your insurance plan allows and what it charges for before you get treatment. We’re always here to offer guidance and answer any questions you might have, but we recommend following this checklist before scheduling your services with us:

1. Make sure we accept your insurance plan

For a list of insurance plans we accept, take a look at the following section (Does Valleywise Health take my insurance?) If you don’t see your plan, call your insurance company and ask if they consider Valleywise Health to be in-network.

2. Find out if your plan requires a referral or authorization

Depending on the nature of your visit, your insurance plan may require a referral or authorization in order to schedule your procedure or specialist visit. Call your insurance company to check on this. If they do require a referral, call your primary doctor first to get it, and then make your appointment with us.

3. Make sure we have your family’s up-to-date health insurance information

Giving us the most accurate information ensures that we can accurately answer your insurance questions.

4. Learn more about the fee for your visit

Call our Eligibility Specialist at (602) 344-2550 and ask what the fee for a physician’s office visit will be. Your total fee will depend on what specific services you might need. Since we can’t always determine what these services will be ahead of time, we may not be able to provide a complete cost estimate in advance (though we will certainly try our best to give you an answer).

If you have a hospital stay, these are the things that will be included in your total cost:

  • The physician’s time spent examining you
  • Any procedures or tests we perform
  • Services including nursing care, supplies, medical machines and equipment and the use of the hospital’s facilities

5. Find out about the services covered by your insurance plan

Most insurance plans ask you to pay a co-pay, deductible or co-insurance. Your plan may also pay differently for certain services (such as labs and radiology) or certain Valleywise Health locations, which may affect what you owe.

All of these amounts are set by your insurance plan. Call your insurance company directly for more information.

6. Be prepared to pay your co-pay or co-insurance at the time of your visit.

If you need to make a payment for your visit, you can pay with:

  • Cash
  • Check
  • Credit card

If you’re not able to pay your co-pay at the time of your visit, our staff will send you a separate bill for it.

Remember, you can always call us with any questions or concerns you might have. Call Customer Service at (602) 344-8181.

Does Valleywise Health take my insurance?

We’ve made it simple to figure out whether or not we accept your insurance. Take a look at the following list to see if your insurance plan has an agreement with us.

For the most part, we accept many major commercial, Medicaid and Medicare insurances. Our agreement with each is different, so the services and costs covered vary based on your insurance provider. Just give your insurance company a call to learn more about what’s covered – your membership card has the number to contact their customer service line.

As part of our commitment to making sure you’re always receiving the best possible care, we want your physician to have easy access to your test results, prescriptions or other doctor’s notes. This makes it easier for your doctors to share important information, prevent medical errors and give you the fast and efficient treatment you need. As a participating provider with the Arizona Care Network, we work together with your insurance company to make sure of this.

Questions? We can help. Call our Eligibility Specialists at (602) 344-2550.

Valleywise Health Insurance List

Understanding your bill

We want to help break down your bill and keep it simple for you. Your total bill will consist of a couple of primary costs: insurance plan-specific costs and our Valleywise Health costs.

Your insurance plan should cover the majority of your visit – however, you’ll still need to pay any co-pays, co-insurance and deductibles that your insurance plan might require.

We will only bill you for the use of our facility and physician-specific costs.

Facility bill (hospital or clinic)

The facility charge covers the cost of running the facility and can include supplies, equipment, radiology, laboratory services, exam rooms, non-physician staff, and other costs. The amount you pay depends on the type of visit and the resources used to treat you and what your insurance covers.

Physician bill

The physicians, radiologist and other specialists may bill you from their practice for their professional services. This includes providers at Valleywise Health’s Roosevelt Campus and all Primary Care and Specialty Care locations.

Questions about your bill? We’re happy to provide more details. Call (602) 344-8181.

Using Valleywise Health direct pricing

Not sure whether you’d like to pay for a medical procedure out-of-pocket? Check out the following guides to help you understand your options and make the best decision for you and/or your family.Below you can find the average discounted self-pay prices for the most common procedures done at Valleywise Health. No two patients or procedures are exactly alike, so the actual price may be different depending on a number of factors, including pre-existing conditions, how long the procedure takes, complications, length of hospital stay, involvement of specialists, and more. In the documents below you can also find Valleywise Health standard charges. These self-pay prices listed are reduced and represent the out-of-pocket responsibility of uninsured patients based on family size and income as it relates to the Federal Poverty Level. Patients with commercial, Medicare or AHCCCS coverage are responsible for out of pocket amounts determined by their insurance company.