You may have heard or seen in recent news articles that beginning January 1, 2019, all U.S. hospitals were required to post a listing of their “standard charges” on their websites. This is a new requirement from the Centers for Medicare and Medicaid Services (CMS), which regulates many aspects of healthcare operations in the U.S. The goal of this initiative is to give consumers access to information about charges for hospital procedures and services.
I strongly believe that transparency is a good thing when it comes to medical care. Patients and the public should have access to information about a hospital’s quality, infection rates, safety, patient satisfaction, and outcomes related specific medical conditions and diagnoses.
In a future Full Circle blog I’ll share more about interpreting public hospital ratings and reports. But in this edition, I want to focus specifically on what we at Covenant Health are calling “Price Transparency” for our hospitals.
If you visit our hospitals’ Price Transparency web pages, you’ll see a long list of procedures and services. Some of the abbreviations and terminology may make it difficult to understand what each item describes. And because a hospital visit includes many services, you would need to know all the service elements of a medical procedure to get a full overview of the total charges.
Most importantly, the amounts posted on the “standard charge” listing are the gross charges for a medical service or procedure. They are not the amounts that patients with or without insurance pay, or that Medicare or other Federal and commercial payers pay, and in fact, may have no correlation with what you will pay.
Patients and insurance companies always pay a significantly discounted amount compared to standard charges. If you have insurance, your actual cost is determined by the price agreements between your hospital and insurance companies, and by your insurance plan benefits. While you may see higher gross charges at one hospital compared to another, this may not affect the amount you will ultimately owe in deductibles, co-pay, co-insurance and out-of-pocket maximums.
Calculating out-of-pocket costs can be complicated. In addition, hospital care often includes services from other healthcare providers such as physician specialists and other practitioners. These providers typically bill patients separately, and their fees are not part of the “standard charge” listing.
To find the Price Transparency information, go to any Covenant Health hospital’s website and look for the links for “Services” or “Patients and Visitors” on the hospital’s home page. The link for “Price Transparency” can be found on the first page that displays under each of these headings. Each hospital’s Price Transparency page also includes a phone number for additional information or help in estimating what you might expect to pay in out-of-pocket costs based on medical charges and your insurance coverage.
Providing information about pricing and other aspects of medical care is an important way for Covenant Health to be the first and best choice for our communities. As 2019 gets underway, I’ll share more details about ways that we are putting our patients first and demonstrating excellence in everything we do.
Wishing you a happy and healthy New Year!