Billing & Insurance
East Tennessee Children’s Hospital Payment Options
East Tennessee Children’s Hospital accepts most health care plans. If your insurance company does not have a contractual agreement with us, our services may be out of network and you would be considered self pay. Patient families should check with their health insurance provider to see if the provider has a contract with us. If no contract exists, the insurance company may require the patient have an out-of-network referral. We will accept the insurance regardless of the referral; however, the insurance company may not cover as much of the cost of the visit as it would for an in-network hospital. The balance of any bill after insurance payments are made is the responsibility of the patient's parent or guardian.
Attention TennCare and CoverKids members:
Renewals start April 1, 2023. Don’t risk a gap in your health insurance!
Verify your contact information with TennCare. You can do this online (TennCareConnect.TN.gov) or by phone 855-259-0701.
Charge Master
We are providing this information based on Federal Guidelines. This does not reflect what you will pay for services. Please contact our office if you have additional questions regarding charges. We can be reached Monday thru Friday from 8-4:30 at (865) 541-8187.
Updated: July 1, 2024
Directions:
Access the Charge Master Download Page
Insurance Providers for Children's Hospital
Children's Hospital has agreements with the following health insurance networks:
TennCare Networks
- Blue Care (BlueCross): BlueCare
- CoverKids of Tennessee (BlueCross)
- TennCare Select (Blue Cross): TennCare Select, TennCare Select BPN Network
- United Health Care Community Plan (UHCP, formerly known as AmeriChoice): United Health Care Community Plan
- Wellpoint
Government Network
- Tricare: Prime and Select
Commercial Health Plans Participation
- Aetna Health Plans: HMO, Open Access HMO, Aetna Select, Aetna Open Access Select, EPO, Open Access EPO, QPOS-Aetna Quality Point of Service, Aetna Choice POS and POSII, Managed Choice, Health Network Option, Open Choice-PPO, Open Access Managed Choice
- Amera-Net: PPO+
- BeechStreet: PPO
- Blue Cross Network P: BlueCard Program
- Blue Cross Network S: BlueCard Program
- CIGNA: Open Access Plus-PPO, HMO and Open Access HMO, PPO, EPO, Cigna POS
- CIGNA Connect
- Coventry Healthcare / First Health: PPO
- Evolutions Healthcare Systems: Select, Select Plus
- First Health / Coventry Healthcare: First Health PPO
- Galaxy Health Network: PPO
- Health Payor's Organization, Ltd: PPO
- Humana ChoiceCare: PPO, HMO, POS-Open Access, PPO, Humana Classic, HumanaOne, CHA, PPOx, HMOx, Choice POS
- Multiplan / PHCS: PPO
- National Preferred Provider Network (NPPN): PPO
- Novanet PPO
- PRIME Health Services: PPO
- Private Healthcare Systems (PHCS) / Multiplan: PPO / TPA's
- Provider Select, Inc: PSI-PPO
- The Initial Group: PPO / TPA's
- Three Rivers Provider Network: PPO
- United HealthCare / United HealthCare of the River Valley: United Choice, United Choice Plus, United of the River Valley, Options PPO
- USA Managed Care Organization: PPO
Patient Notice Regarding Insurance
Download This Patient Notice (Form #32144, Rev. 10/21)
East Tennessee Children's Hospital (ETCH) is required to provide you the following information. If you have questions about this information, please contact our Business Office at 865-541-8187
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- Notice regarding Out-of-Network Providers
While receiving healthcare services at ETCH, the patient may receive treatment from a facility-based physician who may be out-of-network and not have a current contract provider agreement with your insurer.
The physicians and other providers that may treat the patient at this facility may not be employed by this facility and may not participate in the patient’s insurance network. Children’s Anesthesiology participates in all the same plans as Children’s Hospital. They will also reach out to you by text to allow electronic payment.
Anesthesiologists, radiologists, emergency room physicians and pathologists are not employed by this facility. Services provided by those specialists, among others, will be billed separately.
Before receiving services, the patient should check with his or her insurance carrier to find out if the patient’s providers are in network. Otherwise, the patient may be at risk of higher out-of-network charges.
ETCH is contracted with the following physicians and/or physician groups to provide the following services. All plans participate in texting for payment: www.mydocbill.com/etch
- Children’s Anesthesiologists, PC
- Innovative Pathology Services and Solstas Lab Partners (A Quest Diagnostic Company)
- Southeastern Emergency Physicians, LLC
- Pediatric Analgesia and Sedation Specialists
- Neonatology Physician Billing office, Mednax
The patient will be billed for additional charges, including out-of-network charges, if the patient is provided medical services by a healthcare provider that is not in-network. In particular, the patient should ask the facility if he or she will be provided any medical services by anesthesiologists, radiologists, emergency room physicians or pathologists who are not in the patient’s network.
- Notice regarding Out-of-Network Facility
If East Tennessee Children’s Hospital is not a participating facility in your insurance carrier’s network, your child can still receive treatment here. You will receive a bill for the amount unpaid by your insurer, which may be greater than the amount you would pay for services at an in-network facility.
In addition, you may receive treatment from a facility-based physician who may be out-of-network and not have a current contract provider agreement with your insurer.
- Estimate of Charges
If ETCH is in-network for your health insurance plan, you will be responsible for co-payments and deductibles in accordance with your insurance plan, up to the amount of your maximum out-of-pocket expense. This amount is set by your insurance plan. For estimates related to services you may go to our web site at: https://www.etch.com/your-visit/estimating-your-charges/. Here you may do an online estimate based on your insurance plan. For further assistance please contact a Patient Account Representative at 865-541-8187, Monday through Friday, 8 a.m. to 4:30 p.m.
If ETCH is out-of-network for your health insurance plan, you will be responsible for charges in accordance with your insurance plan’s out-of-network coverage. This amount is set by your insurance plan. For assistance in understanding how your insurance benefits apply to your care at ETCH and an estimate of the amount you will be responsible for, please contact a Patient Account Representative at (865) 541-8187 Monday through Friday, 8 a.m. to 4:30 p.m.
- Financial Assistance
ETCH offers financial assistance to patient families in need. Please contact our Business Office at (865) 541-8187 or visit our website, https://www.etch.com/your-visit/billing-insurance/financial-assistance.
Provider-Based Billing
Download this guide to Provider-Based Billing
What is provider-based billing?
Provider based billing is a clinic based in the hospital that is considered a department of the hospital. Even though you are seeing your regular physician in a clinic, your visit is billed under the hospital and not a physician office. You will see charges from the hospital to cover cost of operating the clinic (support staff, supplies, offices space) as well as charges for the provider that sees your child. The clinics uphold the same strict quality standards as all hospital departments and are also monitored by The Joint Commission. Medicare and Medicaid have distinct payment programs for provider-based billing and require we make that public as to which practices are part of the hospital.
What Clinics are hospital Departments and billed under provider-based billing?
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- East Tennessee Children’s Hospital Pediatric Gastroenterology (effective September 1, 2023)
- East Tennessee Children’s Hospital Pediatric Cardiology (effective September 1, 2023)
- East Tennessee Children's Hospital Pediatric Endocrinology
- East Tennessee Children's Hospital Pediatric Genetics
- East Tennessee Children's Hospital Pediatric Hematology/Oncology
- East Tennessee Children’s Hospital Pediatric Neurology
- East Tennessee Children’s Hospital Pediatric Pulmonology
- East Tennessee Children’s Hospital Pediatric Sleep Medicine
Will my child’s clinical care change?
Nothing about your child’s experience will change. You will see the same providers and receive the same level of care.
Will I have to pay more?
Many things can affect the amount you will have to pay. If you have a government plan such as Medicare or TennCare (Medicaid) you will simply see two Explanation of Benefits after care has been received. If you have other forms of insurance, it will be processed as an outpatient benefit under your plan. Based on your plan you may have deductibles or co-insurance that will be applied to your visit. You may want to contact your insurance company to help them better explain your benefits. If you have a secondary insurance, they should pick up and pay any deductible or co-insurance that may apply.
What if I am having a hard time paying for my child’s medical bills?
Please don’t hesitate to contact our Patient Financial Services Department to discuss your concerns. Our customer service team is happy to assist you with different options to help your family ensure your child receives the care they need. They can be reached at 865-541-8187, Monday thru Friday from 8:00 am until 4:30 pm.
Online Bill Pay
We have updated our Online Bill Payment Portal! Please use the Guarantor Number (GN), not the SN Statement Number. It is on the same statement where you would normally find the SN number.
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Opt in to receive electronic statements- Set up payment plans
- Set up recurring payments
- Request an itemized bill
- Notify Patient Accounting of Insurance or address changes
- Option to receive email receipt for Credit card transactions
NOTE: Online Bill Pay requires a separate login from the Patient Portal.
If you have questions about our Online Bill Pay, please call customer service at (865) 541-8187.
Login to Online Bill Pay
Fairness in Billing Practice Policies
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