Frequently Asked Questions

Contact the customer service number listed on your bill with questions or concerns. Below are descriptions of the different types of bills.

A bill generated from Carilion Clinic may include both hospital or hospital-based clinic/wellness center facility charges and healthcare professional charges. As our hospitals and physician offices transition to our new billing system, more hospital and professional fees will be consolidated to this single billing format.

A bill generated from Carilion hospital billing services is from a Carilion hospital or hospital-based clinic or wellness center. Hospital charges are fees incurred for the use of the facility only and usually do not include professional charges for physician interpretations or visits.

A bill generated from Carilion professional billing services is from a Carilion physician or an outpatient clinic (sometimes located at the hospital). Professional charges are generally fees incurred for the care team's expertise and involvement in your care. Depending upon the location and services provided, some facility fees may be present on your professional bill.

A letter generated from Carilion Clinic with an account number prefix including the letters "PPS" is generally for balances that have not been resolved as quickly as expected. These may represent both hospital and professional charges. Contact us to ensure your account does not progress further into collection processes. Our patient service representatives are prepared to review several programs and payment options that may be helpful to you.

A statement with an account number prefix of DRD or CAR generally represents balances for which our other departments have exhausted efforts to resolve your account. These may represent fees from a number of Carilion service lines. Contact our Debt Recovery team with additional questions or concerns.

A bill generated from Carilion Consolidated Laboratories or Carilion Labs includes fees incurred from lab and pathology sent by your care team for study.

Yes, detailed itemized statements are available at your request. Claim forms are available in some cases. Contact the customer service number listed on your bill to make your request. We will mail the information to you as soon as possible. 

If you do not have health coverage, we will try to help you and your family find financial help or make other arrangements. We'll need your help with collecting needed information and other requirements to obtain coverage or assistance.

Medical claim forms are coded using a number system mandated by the U.S. Department of Health and Human Services. Numbers are used to represent visits, tests, procedures and diagnoses. The system was designed to provide for uniform billing and claims processing while protecting patient confidentiality.

Occasionally, coding is not consistent with the procedure that was performed or with the diagnosis that was determined by your doctor. In this case, please call the customer service number listed on your bill. Any information you might provide regarding the conversation with your insurance company will prove helpful for our patient financial services representatives to research your concern.

At times we find that the coding was completed correctly, but is simply excluded from coverage under the terms of specific insurance policies. Once such a scenario is determined through our research, your insurance company will be able to clarify any coverage limitations for the services you received. To prevent such a scenario, it is important to understand these coverage limitations that may be unique to your policy, and clarify beforehand what service you are seeking.

If your address has changed or statements are being sent to an incorrect address, please contact us at the number listed on your bill so that we can correct the address on your account and have future billing statements mailed properly.

Insurance denials can result from many circumstances. The most common reason for insurance not making payment is due to policy deductibles which must be met before any benefits are payable. In addition, denials can result from policy limitations or exclusions for non-covered services under the policy.

Even if a service is deemed to be covered, the insurance company may request additional information before processing payment, such as itemized statements, medical records or even a questionnaire from the insured regarding other coverage or pre-existing conditions.

When a claim is processed, you should receive an explanation of benefits from your carrier that will most likely define the reason for the denial (Medicaid excepted). For more information, you may want to reference your insurance policy or contact your insurance carrier for a detailed explanation.

Carilion Clinic participates with many managed care HMO and PPO plans as well as federal and state government programs. In addition, many local employers contract with Carilion to exclusively deliver services to their employees. In these situations, we may have a contract with the carrier to accept a payment that is less than the total charges (subject to co-pays, deductibles and non-covered services).

When such an agreement is in place, Carilion will post a contractual adjustment discount to align the account balance with the negotiated price. The adjustments are usually posted to the account either at the time of billing or when the payment is received from the carrier.

If you feel that you should have received a discount, or your insurance states that you are not liable for any balance, please contact us at the number listed on your bill so that we can research and correct the account.