Estimate Your Cost of Care

We can help you understand your health care expenses by providing an estimate of charges and out-of- pocket costs for most hospital services here at Valley Medical Center.

Patient RepHow to Request a Cost Estimate

  1. Once you have seen your provider, ask your provider's office for the specific procedure code(s) of the medical procedure he/she recommends.
  2. Complete and submit the cost estimate form below.
  3. One of our Financial Advocates will review your request and call you within three business days to provide information about your estimate. 

Questions?

If you have questions or need additional help, our Financial Advocates are available to assist you. Please call us at 425-656-5599 or visit us at the hospital in person, Monday through Friday between 8:30 AM and 5 PM.

Request an estimate

Please fill out this form


PATIENT INFORMATION

* First Name:

Middle Name:

(enter NMI if no middle initial)

* Last Name:

Email:

* Date of Birth:
 [None] Select a Date Delete the Date
(click first calendar icon to select, second calendar icon to remove)

* Phone:
  

ext.  

 


INSURANCE INFORMATION
*Insurance Carrier:

Specify Insurance Carrier:

* Group ID Number:

* Insurance ID Number:

AETNA Card Premera ID Card Regence ID Card

 


SUBSCRIBER INFORMATION

* First Name:

* Last Name:

* Date of Birth:
 [None] Select a Date Delete the Date
(click first calendar icon to select, second calendar icon to remove)

 


REASON FOR VISIT

* Procedure Code—Description:

(ask your provider for this code. Example: "27130 – Total Hip Replacement")

Comments:
 

 


CONTACT PREFERENCE

* Best Time to Reach You:

(we'll contact you within 3 business days)

 


ACKNOWLEDGEMENT
* Disclaimer:
  Please check here to acknowledge your acceptance
By checking this box, I acknowledge that I am requesting a cost estimate for a procedure(s) at Valley Medical Center. I understand that the estimate will be based on the information I have provided and the most current benefits available from the insurance company. Additional charges will apply if other services are provided that are unknown at the time of this estimate. This estimate may not include all charges for incidental supplies related to the services performed. In addition, this estimate does not include any durable medical equipment, physician, surgeon, anesthesiologist, pathologist, or radiologist charges. Those fees are billed separately by their respective billing agents, and are not included in this estimate.

* How did you hear about this service?:

Specify other source: