Billing Frequently Asked Questions
Frequently Asked Questions
Please call your health insurance company to ask about coverage. Your insurance company will have the most up-to-date information on its contracts with Sutter Health network facilities and doctors. Use the phone number or website on the back of your insurance card.
You can also visit our Health Plan Search to determine which Sutter-affiliated hospitals and medical groups accept your health plan.
When you have health insurance, your deductible, allowable amount, copayment (copay) and coinsurance impact how much you have to pay for medical services.
Because these can vary based on your insurance, contact your health insurance company to learn more. Use the phone number or website on the back of your insurance card.
|Definition||Example||Questions for Your Insurance Company|
Amount you pay for covered health services during a coverage period (usually one year) before your health insurance company begins to pays its portion.
|John’s health insurance plan has a $2,000 deductible per year. John will have to pay the first $2,000 of covered services to reach (or “meet”) the deductible before the insurance company will begin payments.||
Maximum amount a health insurance plan will pay for a covered service.
|Miguel’s health insurance plan has an allowable amount of $20 for a cholesterol test. The Sutter lab charges him $30. Miguel has to pay $10: the difference between Sutter’s cost ($30) and the allowable amount ($20).||
Fixed amount for a covered service. You pay this amount before or at the time of your medical service, lab test or prescription.
|Michelle’s copay is $20 for an office visit and $50 for a hospital visit. She pays this at the time of her visit.||
Share of costs you pay for covered services after you’ve paid your deductible. Your cost is calculated as a percentage of the total procedure cost.
Coinsurance is not a second insurance plan.
|Fatima’s coinsurance is 30%. She has a procedure that will cost $1,000. If she has paid her deductible, she will receive a bill for 30% of $1,000, or $300. If she hasn’t paid her deductible, she’ll receive a bill for $1,000.||
See the ‘Statement Walkthrough’ to answer the following questions:
- What service did I have?
- When did I receive this service?
- Who was the doctor? Where did the service take place?
- Did Sutter send a bill to my insurance company?
- Did my insurance cover the procedure?
- I have insurance, so why am I getting a bill?
Facility billing includes charges for services or procedures received in hospitals,
inpatient and outpatient centers, or from home health or hospice. These charges may
include costs for a room, meals, medications, technicians, nursing, labs, equipment,
therapists or administration.
What is doctor billing?
Doctor billing includes charges for healthcare services provided by a doctor or
other healthcare professional. This includes professional assessment, direction and
oversight. These services may be provided at facilities such as a hospital, surgery
center or medical office.
Why did I get a facility bill and a doctor bill?
When you receive both facility and healthcare services, you often get two bills.
Although the hospital and the doctor may use the same code or language to describe
each charge, their bills are for separate services.
Why do I get bills from doctors that are not within the Sutter Health network?
When you receive services at a Sutter Health entity, sometimes a private (non-Sutter Health) doctor provides your care. This can be an anesthesiologist, emergency medicine doctor, radiologist, pathologist or others. These private doctors work at a Sutter Health facility but are not part of the Sutter Health network.
We try to work with insurance companies that cover both Sutter Health network doctors and private doctors who work at Sutter Health facilities. However, private doctors can’t be required to accept all insurance plans that the facility accepts.
|Facility Services Examples||Doctor Services Examples|
|Ling receives an MRI while she’s in the hospital for two days. She gets a hospital bill for the MRI procedure and the hospital stay.||A private (non-Sutter) radiologist reviews Ling’s MRI while she’s at the hospital. Ling gets a bill from the radiologist.|
|Julie delivers her baby at a local hospital. She gets a hospital bill for the room, meals, medications and supplies she received.||A private (non-Sutter) obstetrician provides care during Julie’s delivery. Julie gets a bill from the obstetrician.|
What is preventive care?
Preventive care is the care you receive to prevent illness or disease. This may
include immunizations, lab tests and screenings. Usually preventive care is provided
during your annual health exam.
What is diagnostic care?
Diagnostic care is the care you receive to treat or diagnose a health problem.
This may include monitoring existing problems, checking new symptoms or running tests.
What is chronic care?
Chronic care is the care you receive for an illness or injury that has been going
on for more than two weeks. This may include treatment for congestive heart failure,
arthritis or a cough that has been persistent for months.
Why does it matter if my care is preventive, diagnostic or chronic?
Your insurance coverage may vary based on what type of services you receive. For example, many preventive services are covered at no cost to you. You may receive different kinds of care at the same healthcare visit.
|Preventive Care||Diagnostic Care||Chronic Care|
|A 55-year-old woman gets a routine annual mammogram to screen for breast cancer.||A 55-year-old woman who notices a lump in her breast gets a mammogram to evaluate the lump.||A 55-year-old woman who had a cancerous lump removed from her breast two years ago gets a follow-up mammogram.|
There are multiple ways to receive price estimates:
- For hospital fee estimates, call Sutter Health Patient Advocates at (855) 398-1637.
- For doctor fee estimates, call Sutter Health Patient Advocates at (866) 961-8566.
- If you’re enrolled in My Health Online (MHO), you can get an estimate by logging in to your account.
- If you’re not enrolled in My Health Online (MHO), you can get an estimate by using the online healthcare cost estimator.
You can pay for your services by:
- Mail — Send in a check upon receipt of your bill.
- Online — Visit the My Health Online (MHO) patient portal. Log in or sign up for an MHO account. Or pay as a guest.
- Phone — For the phone number of your local billing agent or for phone self-service (IVR), visit our Billing and Insurance page.
- In Person* — Pay in person at the hospital or doctor’s office where you received services.
*Due to COVID-19 restrictions and patient safety concerns, we have temporarily suspended some in-person payment options. It is encouraged to pay on My Health Online or by phone.
Payment options include:
- Bank bill pay
- Visa, MasterCard, Discover or American Express credit card
- Health Spending Account (HSA) card from Visa, MasterCard, Discover or American Express
For some Sutter services and facilities, you can make a prepayment online through My Health Online (MHO).
If you authorize a future copay when you make an appointment, your credit card will not be charged until you check in for your appointment. If you cancel your appointment, your credit card will not be charged.
This may happen due to a delay between the time your paper statement was generated and when it arrives at your home. The payment you made will still apply and will be reflected on your next bill.
If you have questions or would like to confirm that your online payment was applied correctly, please contact your billing office or view your My Health Online (MHO) account for detail.
Uninsured discounts are automatically added to your account as applicable.
Sutter Heath offers payment plans to those who qualify. If you would like more
information regarding payment plans, please contact
To set up a payment plan:
- Use My Health Online (MHO) for doctor services only (coming soon for hospital services).
- Contact the billing office for doctor or hospital services.
Sutter Health offers financial assistance to those who qualify.
Refunds for services are available. However, there may be a delay between a refund approval and when it shows on your account or when you receive a check in the mail. Refunds are handled in two ways:
- If you have an outstanding account balance — that is, you owe payment for past medical services—your refund will be applied toward that amount.
- If you don’t have an outstanding account balance, a refund will be issued back to the original credit card or sent as a check. It may take up to 30 days to process your refund.
Each medical service corresponds to a code. Your doctor or healthcare provider selects this code. Sometimes your insurance company may say the code is wrong and suggest it be changed. Mistakes sometimes happen, so please call your doctor or healthcare provider to check that the code is correct.
Pricing is determined by the level of service performed. First, a doctor documents the reason for the visit and any procedures performed. Then, a certified coder reviews this documentation and adds procedural codes for those services.
Sutter sets pricing for all procedure codes. If you have questions about the coding, please call your billing office.
You can also review the Sutter-affiliated hospitals and medical groups that accept your health plan, the hospital chargemaster information and the cost estimator tool on our Healthcare Costs and Charges page.
To request billing records, use our online chat, call the number listed on your billing statement or use the contact information below:
- Hospital Billing (855) 398-1633
- Sutter Gould Medical Foundation (866) 681-0735
- Sutter Medical Foundation (866) 681-0736
- Sutter Pacific Medical Foundation (866) 681-0739
- Sutter East Bay Medical Foundation (866) 681-0745
- Palo Alto Medical Foundation (877) 252-1777
- Legal Billing Records Requests and Legal Billing Subpoena Requests for Hospitals (PDF)