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Billing Services


Billing, Insurance and Patient Financial Services

Consistent with our mission to preserve and enhance a person’s health and function, Gaylord Specialty Healthcare Patient Financial Services is dedicated to providing convenient billing services, customer service and financial assistance. We understand the healthcare billing process can be complicated and are here to assist when needed.


Financial Assistance

Gaylord Specialty Healthcare recognizes that all patients may not have the ability to pay for medically necessary health care.  Assistance is available to individuals that complete the required financial assistance application and meet eligibility requirements.  To request a financial assistance application please contact a patient financial services representative at (203) 284-2827 or print from the link below. Financial Assistance Applications are also available our Patient Registration, Patient Financial Services and Care Management departments. To submit your completed application please mail to:

Gaylord Hospital
Financial Assistance
50 Gaylord Farm Rd
Wallingford, CT  06492

In order to apply for financial assistance you must apply for Medicaid benefits.  Please contact the Department of Social Services at (855)-6-CONNECT or (855) 626-6632 or go to for application information. 

Bill Pay

Pay Your Bill

Credit card payments are accepted online, at registration locations, or over the phone. To make a payment online you will need a copy of the account number, which starts with an "E" listed on your statement. 

Phone: (203) 284-2827

Mailing Address:

Gaylord Hospital
Patient Financial Services
P.O. Box 400
Wallingford, CT 06492

Email Inquiries:


Authorization Form

Due to HIPPA regulations, we are unable to discuss any patient-specific information via email. For patient-specific inquiries please contact the Patient Financial Services offic via phone. See the form and information below for requests for itemized bills or attorney requests. 

Hours: Monday – Friday 8:00 a.m. – 4:00 p.m.

To request a copy of your medical record or an itemized bill, please print out and complete the form below. 

Mail the completed form to:

Gaylord Specialty Healthcare
Release of Information
P.O. Box 400
Wallingford, CT 06492

Or fax the form to: (203) 284-2952

We will process your request as quickly as possible but it may take up to 30 days to receive. Please let us know if it is needed for the continuation of your medical care, so we may assit with expediting.

If you have any questions about how to obtain a copy of your medical record, please call (203) 284-2885 or email us at

Due to HIPPA regulations, we are unable to discuss any patient-specific information via email. Please note that there may be a fee for copying and providing your record. You will be billed accordingly. 

Ethical Billing

Ethical Billing Practices

Insurance & Pricing

Insurance & Pricing Information

Health insurance benefits are verified prior to initial service. Gaylord Specialty Healthcare participates with most insurance networks. Please bring your insurance card with you to insure information is accurate. Copays will be requested prior to services rendered.

Accepted managed care plans including but not limited to:


  • Aetna
  • Blue Cross
  • Cigna
  • Connecticare
  • Harvard Pilgrim
  • Mulitplan
  • Oxford
  • United Healthcare
  •  Yale Health Plan


  • Medicare
  • State of Connecticut Medicaid
  •  VA Community Care  Network(managed by Optum)

Medicare Advantage

  • Aetna Medicare Advantage
  • Blue Cross Medicare Advantage
  • Carepartners of CT
  • Connecticare Medicare Advantage
  • Wellcare Medicare

Pricing for Services 

Gaylord Hospital wants to help patients make informed health care decisions.  Because that includes having an understanding of your out-of-pocket costs for our services, we make available our chargemaster.

What is a charge master?

A chargemaster is a comprehensive list of charges for each service or item provided by a hospital.  This includes each test, exam, procedure or any other service.  Given the many services provided by hospitals, a chargemaster contains thousands of services and related charges.

Chargemaster amounts are almost never billed to a patient or received as payment by a hospital.  The chargemaster amounts are billed to an insurance company and those insurers then apply its contracted rates to the services that are billed.  In situations where a patient does not have insurance, our hospital has a financial assistance policy that applies discounts to the amounts charged. 

Health insurance companies contract with hospitals to care for their customers.  Hospitals are paid the insurance company’s contract rate, which generally is significantly less than the amount listed on the chargemaster.  The insurance company’s contract rate, not the chargemaster, is the basis for determining the patient’s actual out of pocket costs.  As an example, a hospital may charge $1,000 for a particular service, while the insurer’s contract rate may be $500.  If the patient’s insurance plan indicates the patient is responsible for 20 percent of the contract rate, the patient would owe $100 ($500 x 20 percent).

Are the charges the same for every patient?

The list of charges is the same for all patients.  However, the total charges for an individual patient often vary from one patient to anther for a number of reasons, including:

- How long it takes to perform the service

-The services requested in the plan of care determined by your provider

- Whether the service you receive is more or less difficult than expected

-Whether you experience complications and need additional treatment

-Other health conditions you may have that may affect your care

Is the charge the same as what a patient pays?

Chargemaster information is not particularly helpful for patients to estimate what health care services are going to cost them out of their own pocket.  The charge listed in the chargemaster is generally not the amount a patient will pay.  If you have health insurance, the amount you will be billed and expected to pay for your series depends on your specific health insurance coverage and your insurance company’s contract with the hospital.  If you do not have health insurance you may be eligible for reduced costs under the hospital’s financial assistance policy, or you may be eligible for Medicaid coverage.

What is not included in the charge master list?

The hospital’s chargemaster does not include charges for services provided by all doctors who treat you while you are at the hospital.  You may receive separate bills from the hospital and the doctors involved in your care.  Here is a partial list of health care providers who may bill you separately:

- The hospitalist who sees you in the hospital

- The radiologist who reads your x-rays or other imaging

- Other doctors who may be consulted by your doctor during your time in the hospital

Price Estimates 

Patients covered by private health insurance are encouraged to contact their insurance carrier to understand their financial responsibilities.  Contact information for your insurance carrier can be found on the back of your health insurance card or by visiting the carriers website.  You can also call the Gaylord Hospital Patient Financial Services department at (203) 284-2827 or email

Rights and Protections Against Surprise Medical Bills

Rights & Protection

You are protected from balance billing when you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance, and/or deductible.

What is "Balance Billing" (sometimes called "Surprise Billing")?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copaymentcoinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit. 

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You're protected from balance billing for:

Emergency Services 
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

When balance billing isn't allowed, you also have these protections:

You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.

Generally, your health plans must:

  • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you've been wrongly billed, you may contact:

  • The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit for more information about your rights under federal law.
  • Your health plan to ask them why you got the bill and if it’s correct. If it was an emergency, ask your health plan if they processed your claim as an emergency.
  • The State of Connecticut, Division of Insurance Consumer Helpline can also be reached at: (800) 203-3447 or (860) 297-3900 or Send an E-Mail to: