Questions to ask your insurer

Is OHSU in network for my plan? Is my OHSU health team in network for my plan?

• In network: Your insurer has a contract with OHSU and/or your health team. Your costs will be limited.
• Out of network: Your insurer does not have a contract with OHSU and/or your provider. You will pay more.

What does my plan cover?

Your insurer will have the best information about what services, treatments, medications, medical equipment and fees it covers.

Do I need prior authorization?

Before getting care, medicine or medical equipment, your health plan may need to approve it as medically necessary. This approval is called prior authorization, also known as preauthorization or precertification.

Out-of-network benefits

OHSU generally does not accept out-of-network benefits when in-network options are available. This helps patients avoid unexpectedcosts .  

Without a contract in place, we can’t provide reliable cost estimates before care. That means you could receive a large bill.Federal regulations, including rules for Medicare Advantage plans, also limit when out-of-network coverage can be used.  

If a service is only available at OHSU in Oregon or the region, we will work with your insurer to seek approval for care.

Self-pay

If you have nsurance and can get the same services from an in-network provider, we recommend using your insurance benefits. 

If you still choose to come to OHSU for care, you can pay without billing your insurance, also known as “self-pay.” If you choose self-pay, please note: 

• Financial assistance will not apply.  
• Medicare Advantage plans do not allow self-pay for Medicare-covered services. 
• Self-pay is accepted for elective procedures, like genetic testing or cosmetic surgery, not covered by your plan. Always call first to check.  

Understanding your bill

Your bill may include charges for:

• Provider services
• Hospital services
• Facility fees

Provider services: These are charges from doctors and other health care professionals who took care of you.

Hospital services: These are charges for other parts of your care, including supplies and medications.

Facility fees: These are charges for some visits to OHSU clinics. We follow facility fee rules set by the federal Centers for Medicare & Medicaid Services. These fees are meant to cover the costs of running the clinic.

If you had anesthesia: You may get a separate bill for that service.

How to read your bill

You will receive one bill for both hospital and health team services. Use this guide to understand what each part of your statement means.

No surprise billing

Federal and Oregon law protects you from surprise medical bills. In many cases, you cannot be charged more than you would pay for in-network care.  

You are protected from surprise bills for: 

• Emergency care  
• Certain services from an out-of-network provider or an in-network hospital. Examples include: 
• Anesthesia 
• Laboratory 
• Newborn care 
• Pathology 
• Radiology (imaging) 

If you think you were billed incorrectly or got a surprise bill, contact: 

• U.S. Department of Health and Human Services: 800-985-3059  
• Oregon Department of Consumer and Business Services: 888-877-4894 

Learn more: What is a “surprise medical bill” and what should I know about the No Surprises Act? 

OHSU price list

We have the same pricing for all patients, but what you actually pay depends on your insurance plan. If you don’t have health insurance or don’t have enough insurance, you may qualify for discounts. Visit our financial assistance page or call 503-494-8505 to learn more.

Download our pricing list

Get a cost estimate for your care

If you have health insurance: 

You can get an estimate of your costs by: 

• Contacting your insurer and asking for an estimate. 
• Calling our Patient Estimate Team at 503-494-3508 to ask for an estimate. 
• Using our online price estimate tool. 

If you don’t have or are not using health insurance: You have a right to receive a Good Faith Estimate (GFE) of expected costs for your care. 

A GFE is a written estimate of the total expected cost of nonemergency medical services and items. It may include estimates for: 

• Medical tests 
• Health team fees 
• Prescription medications 
• Medical equipment 
• Hospital fees 

Here’s when to request a GFE: 

• At least 3 days before scheduled care appointment: You have a right to receive a written GFE. 
• Less than 3 days before scheduled care appointment: Call our Patient Estimate Team at 503-494-3508 to ask for an estimate. 

If your bill is $400 or more above the GFE, you may have the right to dispute the bill.  

Be sure to keep a copy of your GFE for your records. For more information about your rights, visit Centers for Medicare & Medicaid Services No Surprises.

Billing for MyChart messages

We may bill you or your insurance if you send us a medical message in MyChart that:

• Involves a medical decision.
• Takes your provider more than five minutes to answer.

As virtual care becomes common, we spend more time answering MyChart messages. Billing for in-depth answers lets your provider:

• Take the time to look at your medical history.
• Give you the best advice.

Please message your provider through MyChart only if you are willing to possibly be billed.

If you have Medicaid (Oregon Health Plan): MyChart messages are free.

If you have Medicare or other health insurance: We will charge a co-pay as if you had an in-person visit. If you don’t have a co-pay, you may be responsible for an out-of-pocket charge. This can vary by insurance coverage. Your deductible applies.

To see how much you’ll pay under your insurance plan:

• Go to our price estimate tool. Use CPT code 99423.
• OHSU patients:
  • Email estimates@ohsu.edu.
  • Call 503-494-3508.

If you don’t have insurance: You will receive a 35% discount on the total charges.

More ways to pay your bill

By mail:
OHSU Patient Billing Services
P.O. Box 575
Portland, OR 97207-5975
(Please include payment coupon.)

In person:
Fifth Avenue Building
1400 S.W. Fifth Ave., Suite 500
Portland, OR 97201