CaveatsPrices Do Not Necessarily Equal Out-of-Pocket Costs.
When you receive a price estimate from this hospital, please keep in mind that this is likely not the amount you will pay out of your pocket for the procedure.
If you have health insurance, your out-of-pocket costs may be much lower. You need to consult your policy and speak with your insurance company to determine your share of the costs.
Generally speaking, health insurance companies pay the largest share of the cost of most health care procedures. However, your insurance company might require you to pay a co-payment or co-insurance.
A co-payment is typically a flat fee for receiving a service, such as the amount you pay to visit a doctor or fill a prescription.
Co-insurance is typically a percentage of the total price of a particular service, such as the insurance company will pay 80% and the patient will have a co-insurance responsibility for the remaining 20%.
A deductible is the amount you pay for healthcare services before your health insurance company begins to pay. A deductible is typically a fixed dollar amount such as $1,500. This means that you may need to pay $1,500 for healthcare services before your insurance company pays. The amount you pay for monthly premiums does not count.
The amount of your deductible can vary significantly depending on whether you have individual insurance coverage or family coverage and whether you have a “high” deductible plan or a “low deductible” plan. And remember, the amount of your deductible also depends on whether you’ve consumed any healthcare services this year.
The policies related to co-pays and deductibles also can vary significantly if you have government health insurance such as Medicare or Medicaid.
So, please contact your health insurance company to understand your share of the price of your health care procedure.
Charges vs. Prices.
The federal government requires hospitals to keep a list of “charges” for all procedures the hospital performs. You may see that list price in different places. For example, if you have health insurance, the “Explanation of Benefits” that you receive from your health insurance
company will frequently include a ‘charged’ amount for your procedure. However, that is typically not the actual price for the procedure. Health insurance companies and government payers frequently negotiate, or impose, lower prices called the “allowed amount.” The allowed amount is the actual price for the service.
Is It Covered?
If you have health insurance, please remember that health insurance policies do not cover all procedures. These procedures are often called “elective” by your health insurance company if it deems the procedure is not medically necessary. Consult your health insurance plan description and contact your insurance company if you have questions about whether a certain test or procedure is covered.
If you are receiving a medical procedure like surgery, your price estimate may reflect a range of prices rather than a single amount. That is because surgeries can involve unknowns, unanticipated risks or other complications that can increase the cost of your care. Ask your doctor to describe the kinds of potential complications associated with your care.