“Pricing Transparency” is the term used to describe initiatives in the healthcare industry to provide meaningful pricing information to consumers. The healthcare industry is often complex and difficult for consumers to navigate. Price transparency is a means of providing consumers price information on common services.
If you have insurance or some form of medical coverage, your out of pocket typically can include a deductible, co-insurance, co-payment, or even non-covered services. The prices for your services are based on the contract terms negotiated by your insurance company with the hospital and the benefits of your contract. Your carrier could have a contracted rate (approved) for the particular service that has been ordered for you and your portion will depend on your contract and the approved rate.
If your physician orders a laboratory procedure that we do not perform here and we have to send it to a reference lab we will not have a charge until we receive that charge amount from the reference lab.
Most Observation stays (less than 48 hours) and outpatient surgeries are paid by procedure codes instead of charges by insurance carriers. Your portion is based on their approved amount and any deductibles or co-payments that are due.
Most inpatient stays are paid by Diagnosis by insurance carriers. Your portion is based on their payment and any deductible or co payments that are due.
If you are Uninsured you may be eligible to receive a discount based upon your income and net worth.
Please have the following items ready prior to calling or emailing us for a price quote:
- Description of services needed (Order) – we will need to know as much information as possible about the specific services as described by your physician.
- Type of Services needed – we need to know if you will be admitted to the hospital as an inpatient overnight, or if you are expected to be treated on an outpatient basis.
- Physician/Specialist Name – example, if you are having surgery, we will want to know the surgeon’s name.
- Your Insurance Card – please have your card available.
- Your Deductible, Coinsurance, Out-of-Pocket Max and Co payment amounts.
- Policyholder’s Personal Information – it is possible that the insurance company will want us to verify the Social Security Number and date of birth of the person who is named as the primary insurance policy holder.