Fee Estimates

Frequently asked questions about fees

As patients become responsible for a larger part of their health care expenses, obtaining an estimate for those expenses is wise. Marshfield Clinic is committed to providing patients with price and quality information for commonly used clinic services.

With some goods and services, you can measure value by cost alone. But health care is not something you want to leave to the lowest possible bidder. You need to look at the total cost of care and your health care provider’s quality outcomes (if available), not just the fee for an office visit or specific procedure, to determine if you’re getting value.

Who can I contact for a fee estimate?
Call our Patient Assistance Center at 1-800-782-8581, extension 9-4475. You do not need to be a Marshfield Clinic patient to call.

What questions do I need to ask my doctor or health care professional in order to obtain a fee estimate?
Marshfield Clinic fee estimates are based on the information we receive from you. It is important for you to obtain detailed information about your upcoming service such as:

• What service(s) will be performed? (Such as, office visit, screening exam, lab work, immunization, surgical procedure, anesthesia,).
• Where will service(s) be performed? (Office, surgery center, hospital)
• What codes will be used to prepare billing?

What does the fee estimate include?
Your fee estimate will include the description of the services, procedure codes and Marshfield Clinic’s billed charge.

In some cases, if your doctor or health care professional performs more than one procedure on the same day, Marshfield Clinic passes the cost savings to patients and reduces the amount owed (percentage varies) by the patient or insurance company.

Please note that if your doctor or health care professional performs your procedure in a non-Marshfield Clinic facility, our fee estimate will not include that facility’s charges. Be sure to contact that facility for information about their billed charges.

Where can I obtain a list of procedure codes? Is there a website I can use?
Health care professionals and insurance companies use CPT codes to describe services provided. Currently, there are no websites for the general public to access CPT codes. We encourage you to ask your health care provider or their business office for this information.

For an office visit, what determines the level of visit I will be charged?
The complexity of your visit, your medical history, the physical exam performed, as well as needed diagnostic procedures all factor into determining the level and fee for an office visit. Time spent counseling a patient and coordinating care will also be factored.

Is this estimate the total cost?
Your fee estimate will include costs for the services you have requested. In some cases, your doctor or health care professional may need to perform additional services during the procedure. For example, if a routine colonoscopy detects a polyp, your doctor may remove it and send it to a laboratory for testing. You will incur an additional charge not included in your original fee estimate for removing the polyp and the laboratory fee.

Do fees vary for a procedure?
Marshfield Clinic fees are standard throughout the system. However, where a procedure is performed will impact the total cost (doctor’s office, surgery center, hospital).

How much will my insurance pay?
Coverage and/or payment is dependent upon your individual policy at the time of service. Contact your insurance company with the procedure information and they can tell you what is covered and how much it will pay.

What is my payment responsibility after insurance pays?
You are responsible for paying the difference between the amount Marshfield Clinic billed your insurance company and the amount your insurance company paid.

If I pay at the time of service, do I get a discount?
There is no prepayment discount.

Do you have programs to assist me with health care costs?
If you do not have health insurance or need assistance in paying your medical bills, please contact our Patient Assistance Center at 1-800-782-8581 ext. 9-4475.