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Estimates Help

Welcome to the Estimates Help Page! The sections below provide more information about estimates and answer commonly asked questions.

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What is an estimate?

An estimate is the predicted amount you will pay for a defined medical service based on the information we have at the time the estimate is created, including your insurance coverage and historical data on what a typical patient has been charged for the medical service. Estimates are for informational purposes only and are not guarantees of your final out-of-pocket cost for the service. Your actual costs may be different based on changes to your health plan design, deductibles/co-insurance and out-of-pocket limits, the clinical services provided, and/or the location you’ve selected. Estimates only include the fees charged by UNC Health.

How are estimates created?

Estimates can be created one of two ways: through the estimator in My UNC Chart, or by a member of the UNC Health staff. Depending on your selected service and location, there are two major components of your estimate:

  • Facility Fees: Fees associated with services and supplies provided by the hospital or hospital-based clinic where you receive care; this may include fees associated with your room, supplies used during your visit, and/or support staff (ex. nurses, technicians)
  • Professional fees: Fees associated with services rendered by your care provider(s): you may receive separate bills for one ore more care providers based on the type of service you receive (ex. primary care providers, surgeons, anesthesiologist) and your chosen location.

Estimates attempt to provide you a complete picture of your expected out-of-pocket costs, including both facility fees and professional fees (where possible) in your estimate. However, professional fees charged by care providers and organizations who are not employed by or contracted with a UNC Health entity are not included and may bill separately.

Once you’ve selected your desired service and location, your current insurance benefits are applied to create your estimate. We recommend you create your estimate as close as possible to your expected visit date to make sure your latest benefit information is applied. A variety of other factors also have an effect on the estimate result, including the following:

Factor

Description

Assumption

Ancillary Services

Additional services vital to the delivery of your selected service (ex. anesthesia)

Estimates include all ancillary services where possible. If an ancillary service is delivered by a non-UNC care provider, you may receive a separate bill.

Preventative Services

Services that may be covered at 100% by your insurance carrier (ex. mammograms, colonoscopies)

Estimates are for diagnostic procedures only. For information on what is considered “preventative,” please contact your insurance carrier.

Care Provider Type

Services that may be delivered by more than one type of care provider (ex. office visits)

Estimates use a care provider type most commonly associated with the service at hand. This is usually a doctor.

Visit Severity

Services that vary based complexity of the problem at hand (ex. office visits)

Estimates use low to moderate severity when more than one level may apply.

Comorbidities

Patients with more than one chronic condition (ex. hypertension, diabetes)

Estimates do not factor in comorbidities when calculating your expected out-of-pocket cost.

Complications

Unforeseen issues that may occur during the delivery of care (ex. sepsis)

Estimates do not factor in complications when calculating your expected out-of-pocket cost.


Additionally, separate services provided during the same visit (ex. deliveries and newborn care) and services that depend on what your care provider finds during your visit (ex. routine colonoscopies vs. colonoscopies with a biopsy or lesion removal) may require multiple estimates to obtain a better picture of your expected out-of-pocket costs.

Please review the “This estimate includes / does not include:” section of your estimate to identify when you may receive separate bills and learn more about what goes into your estimate.

Estimator Availability

Use the applicable links below for list of insurance plans, services, and locations available for estimates through the estimator in My UNC Chart.

If you do not see your desired option(s), please call the UNC Health Estimates Team at (984) 215-6899, Monday – Friday, 8:30 a.m. - 4:30 p.m. (except major holidays). Note that some services are only offered at select locations, and the list of plans does not include all insurance plans accepted by UNC Health. To see a general list of accepted insurance plans, visit the Insurance Accepted page.

Key Insurance and Billing Terminology

View our billing terminology page to read key terms related to estimates, billing, and health insurance.

Frequently Asked Questions

View our list of frequently asked questions.