What is a charge?
A hospital charge is a federally-required maximum list price for an item or service that does not reflect any negotiated discount. Federal reporting rules require hospitals to maintain a catalog of tens of thousands of procedure codes, code descriptions and list prices in a complex accounting tool, known as the hospital chargemaster. Although virtually no one pays full charges, federal regulations require hospitals to uniformly apply the full list price or charge to all patients who receive a specific item or service.
How are charges different from actual payments?
Medicare and Medicaid reimburse hospitals using complex formulas that often pay less than the actual cost of providing care. Private health insurance plans also negotiate significant discounts. Uninsured patients often qualify for hospital financial assistance policies, including free care. Media reports often confuse charges with actual or expected payments. These news stories also neglect to mention that hospitals’ uncompensated care costs – the difference between actual payments and the cost of providing care – reached $38.3 billion in 2016. (Source: www.aha.org/system/files/2018-01/2017-uncompensated-care-factsheet.pdf)
How can consumers receive a clearer customized estimate of their out-of-pocket costs?
When planning an elective procedure, insured individuals should contact Medicare or their commercial health plan for information on plan design, provider networks and out-of-pocket payment responsibilities, such as deductibles, coinsurance and out-of-pocket maximums. Patients should also contact a hospital financial counselor to request a customized total estimated price of services.
What other hospital comparison tools exist to improve transparency for consumers?
Medicare provides a comparison tool for consumers at www.medicare.gov/hospitalcompare/about/what-is-HOS.html. This website offer tools for consumers who want to compare value, including surveys of patients’ experiences and information on timely and effective care.”
Please click on the facility name below to view their chargemaster.
Patients can be referred to our hospitals from various healthcare providers, including hospitals, family physicians, specialists, case managers, social workers, home health agencies and skilled nursing facilities. Click here for more information