Each hospital has its own policy for setting prices. Hospital charges vary because they reflect the individual hospital’s mission and the Patient population it serves. A hospital that provides highly specialized services, such as trauma units or dedicated intensive care services, like Nexus Children’s Hospital , has a different cost structure and pricing than one that does not. Prices are reviewed each year on Jan. 1, and are subject to change during the year. To establish prices, we consider many factors including:

• The cost of staff, equipment, medications and other supplies involved in Patient care

• The amount of time our facilities and staff are involved in providing services

• The cost of administrative expenses such as billing, technology, housekeeping, etc.

• Insurance company contracts

• Information provided by the Centers for Medicare and Medicaid Services, the federal agency that manages the Medicare and Medicaid programs

Here’s an excerpt from the AHA’s “Detailed Summary of No Surprises Act”:

https://www.aha.org/system/files/media/file/2021/01/detailed-summary-of-no-surprises-act-advisory-1-14-21.pdf

Not necessarily. In addition to your hospital charges, you could receive separate bills for physician’s fees from your surgeon, anesthesiologist, radiologist, emergency room physician and other specialists. Please contact those offices directly for price information (713) 351-6633.

CPT stands for Current Procedural Terminology. A CPT code is a five-digit code used by all hospitals, physicians, and insurance companies to identify a type of service or procedure. You will see CPT codes located on our pricing lists to help ensure that you are viewing the price information for the specific procedure your physician has ordered.

DRG stands for Diagnosis Related Group. A DRG is only assigned to an inpatient hospital service. DRGs are universal groupings used by Medicare and most insurance companies to clarify the type of inpatient care a Patient receives. Insurance companies use the DRG code, along with a diagnosis/CPT code and the length of the inpatient stay, to determine payment and reimbursement for claims.

Charges for many common, high-volume procedures are listed on our site. Additional service areas are being added regularly. Please contact Nexus Children’s Hospital Patient Estimates Team at (Email) or call (713) 351-6633 for estimates information on a procedure not listed.

The amount you owe may vary due to a number of circumstances: Additional testing, medications, services or procedures ordered by your physician. The procedure planned may not be the procedure performed based on your physician’s assessment.

Our Patients’ safety and preventing hospital-acquired infections is a major focus at Nexus Children’s Hospital . We are proud that we perform better than national benchmarks in the majority of categories of hospital-acquired infection rates. Our Caregivers are dedicated to improving in this area, and it remains a constant priority for Nexus Children’s Hospital . For more information on the quality and transparency commitment, please see our WEBSITE.

Call your insurance provider directly to verify that Nexus Children’s Hospital is in your network. Nexus Children’s Hospital will file claims to any insurance company you authorize, but your employer and insurance company determine your level of coverage. An insurance contract between your insurance company and Nexus Children’s Hospital doesn’t guarantee that your claims will be paid in full. You’re responsible for payment of services not authorized by your insurance company and any balance remaining after insurance payments and adjustments have been applied.

Yes. In an emergency, always go to the closest hospital. Your insurance provider generally will cover emergency department costs or recommend a transfer to an "in-network" hospital when it is safe to do so. If you choose to go to an "out-of-network" hospital in a non-emergency, you may be required to pay a larger deductible or a greater portion of your bill. Call your insurance company to find out your health plan’s "out-of-network" options.

We will do our best to provide you with an estimate price based on our hospital’s charges for comparable services and your insurance information, if applicable.

We do our best to provide you with an accurate estimate. However, your actual bill might vary, and our estimates are not guaranteed because the services each patient requires can vary, and your bill will be dependent on your individual circumstances at the time your services are rendered. Your health plan may require a co-payment or deductible that will be due during appointment registration. Check with your provider on the amount that you will be responsible for at this time. Following your healthcare services, your insurance provider will send you an Explanation of Benefits (EOB), which will detail the amount it has paid, any non-covered or denied amounts, and the remaining balance that you are responsible for paying to Nexus Children’s Hospital . Review this EOB, compare it to your Nexus Children’s Hospital billing statement, and call your insurance provider or a Nexus Children’s Hospital Customer Service if you have questions or concerns.

Your personal physician or other physicians providing you with services related to your hospital stay or visit will bill you separately. This can include fees related to specialists, anesthesiologists, pathologists, and radiologists.

Independent laboratory and radiology services will also bill you separately for reading and interpreting EKG’s, X-rays, EEG’s and lab work.

Prices can vary widely depending on whether your hospital is in- or out-of-network for your specific health plan. Out-of-network hospitals have not been able to negotiate a discounted price with your insurer, thus making you potentially responsible for higher personal payments.

Even if your hospital is in-network, you may receive care from an out-of-network physician. If possible, always find out if all physicians who will treat you are within your health plan’s network. This includes but is not limited to: anesthesiologists for surgery or pregnancy delivery along with pathologists, radiologists or consulting doctors. If they are not within network, ask if they will accept in-network payment for services provided to you. If you’re concerned that your doctor may be out-of-network, contact your insurance company.

Yes, services and procedures may be different based on age and level of health (for example, uncontrolled diabetes and high blood pressure).

Yes. Nexus Children’s Hospital Financial Assistance Specialists assist individuals and families that have health insurance but who need additional financial resources to cover medical bills. We can identify and help you apply for programs including Medicaid, Social Security, and other financial assistance.

We can help you determine if you are eligible for government programs, a product on the Health Insurance Marketplace, or financial assistance through Nexus Children’s Hospital ’s Community Financial Aid program. Please note: emergency services will never be delayed or withheld on the basis of a patient’s ability to pay.

For general care, if you do not have health insurance, call the Nexus Children’s Hospital Patient Financial Services Department at (713) 351-6633. The Nexus Children’s Hospital Financial Assistance Specialist will review payment and financial assistance options that may be available to you. Discounts vary and are based on family income and size. To receive discounts and payment plans, or to apply for other financial aid programs, you will need to fill out an application and meet certain requirements.