Billing and insurance

Your responsibilities before and after a visit

Health care billing and payment can be complex and confusing -- but it doesn't have to be. Here are some tips to help you prepare for paying for your care.

Before scheduling your hospital or clinic visit

Before the day of your appointment, there are a few steps you need to take to help avoid surprises.

1. Check with your health plan or employer to understand:

  • What your access and insurance coverage amounts are for receiving health care services at Duke.
  • What deductible, copayment, or coinsurance amounts you may owe after treatment.
  • If your estimated payment due will be greater than $250.
  • If you need prior authorization for elective services.
  • If you are required to notify your primary care physician to obtain a referral to see us.
  • If and what you will be required to pay at the time of service (if your health plan decides that your service was 
not medically necessary, is a pre‐existing condition, or is not a covered service). 

To speed up your check‐in process, you may pay your estimated balance due prior to your date of service.

2. Be sure to review our list of specific health plans accepted by Duke Medicine. This page includes information on 
health insurance plans, national transplant networks, and Medicare Advantage. We make every effort to keep this information current. However, it is subject to change at any time without notice.

3. Bring your complete health insurance information when you register including:

  • Personal identification
  • All insurance cards
  • Authorization forms 

You may be asked to sign some forms, such as a release of information, depending on your visit. 
Additional Resources: Patient Billing Brochure (PDF link) or Patient Billing Brochure (Spanish ‐ PDF link) 

During your hospital or clinic visit

All patients

1. Inform us of any changes with your information including:

  • Address
  • Insurance

Information that is not current can cause payment delays or denials that may ultimately 
leave you responsible for paying the balance.

2. Expect required payments such as:

  • Previous balances
  • Co‐payments for both physician and hospital care
  • Estimated coinsurance or deductibles as required by your health plan
  • Deposits or full payment for certain services not covered by insurance

The person who consents to medical treatment, including the legal guardian of a child, will be financially responsible for the bill. 

Medicare patients

1. You will be asked a series of questions required by law at each visit regarding:

  • Your status, including other insurance you may have
  • Your retirement date

If you are covered by Medicare, we will submit your claims to Medicare on your behalf.

 2. You must sign a notice that holds you financially responsible for the services we provide to you. This is just in case Medicare deems the services not medically necessary and does not cover the services.

After your hospital or clinic visit

All patients

1. Pay your bill in one of four ways:

  • Online using a MyChart account
  • By mail with check or credit card, within 15 days after receipt of statement, following the instructions on the statement
  • By cash at the time of service or as a walk-in to the Customer Service Department located at 5213 South Alston Avenue, Durham, NC 27713
  • Apply for financial assistance if applicable

Medicare patients

  • Expect a bill to you and/or your supplemental insurance carrier for services not covered by Medicare, such as medications you give yourself and routine health exams.
  • Expect to pay if Medicare or your supplemental insurance does not cover the services that we provided.

Amounts generally billed

Patients who do have insurance or other third party coverage will get a discount on their bill equal to the best discounts we offer to insurance companies.  This discount is automatically applied to your bill.  If you believe that you are eligible for this discount and we have not provided it to you, please contact us.


Pre‐visit collections

Duke University Health System and the Private Diagnostic Clinic provide estimates of how much patients will owe after insurance for select services that tend to cost patients slightly more out-of-pocket, including: 

  • Duke Radiology
  • Ambulatory Surgery Center
  • Duke Hospital Operating Room
  • Duke Hospital Admissions
  • Duke Regional Admissions
  • Durham Regional Outpatient Surgery 

For the  services, one of our skilled financial counselors will give you the opportunity to pay this amount by phone prior to your service. The financial counselors will:

  • Provide an estimate of your liability after insurance
  • Assist you with payment options

You can also pay this amount at the time of service.

Post‐service collections

We will send you monthly bills for any unpaid balances for up to 120 days after treatment. During this 120-day period, we will contact you four times via statements, phone calls, and/or e‐mails to remind you about your unpaid balance. During this period, you are expected to either:

  • Apply for financial assistance
  • Establish an interest-free payment plan
  • Pay your bill in full

After the 120-day period, if you do not take one of the three actions listed above, then your account will be sent to a collection agency. Your credit report may reflect the unpaid bill 60 days after collection agency placement. 
In select cases, DUHS may choose to engage an attorney to collect payment. This step would occur only after DUHS has thoroughly reviewed the account and determined that your are not eligible for financial assistance or other forms of coverage. 

All patients have the right to receive an itemized statement that provides details of the charges related to their visit upon request.  Itemized statements can be obtained by calling customer service.

All patients have the right to dispute their charges and to have their bill reviewed to ensure that the charges are accurate and supported by the medical record. Patients may request this review by calling customer service or sending a request in writing to the address listed on their statement. At the conclusion of this review, any necessary corrections will be made and findings will be communicated to the patient.

Patients have the right to appeal if a bill is reviewed and the billing is found to be accurate. Patients may request an appeal in writing to the address listed on their statement or by calling the customer service. These appeals will be reviewed by the Patient Billing Appeals Committee and all decisions will be sent in writing to the patient within 15 business days after receipt.

Patient overpayments that are identified will be refunded to the patient within 30 business days. Patients that wish to expedite their refund can call customer service.

Contact us

If you have a question about your bill, contact our Customer Service Center and request to speak with a Patient Account Representative.

919-620-4555 or 800-782-6945

Monday through Friday, 8 a.m. to 5 p.m.