Transparency of Hospital Charges FAQ

Transparency of Hospital Charges FAQ

1. How much will I actually have to pay out of my pocket?

For insured patients, health plans such as Medicare, Medicaid, workers' compensation, commercial health insurance, etc., do not pay charges. Instead, they pay a set price that has been predetermined or negotiated in advance. The patient only pays the out-of-pocket amounts set by the health plan. Therefore, a patient with health insurance needs to pay the deductible, copay and/or coinsurance set by their health plan.

The financial obligations could differ depending on whether the hospital or physicians are "out-of-network," meaning the health plan does not have a contract with them. Contact your insurance company to understand what your financial obligations will be.

If you need help understanding your health care bill, please contact the Hospital's Billing Department.

A patient without health insurance will be able to discuss financial assistance options available that could include either a complete write-off or a substantial reduction of the charges in accordance with the Illinois Hospital Uninsured Patient Discount Act and the hospital's financial assistance program.

Please visit the Patient Financial Assistance section of the hospital website at www.jch.org or inquire about the financial need assistance program and Illinois Hospital Uninsured Patient Discounts with the Hospital's Patient Financial Counselor for further assistance.

2. What do the following health insurance terms mean?
Deductible means the amount the patient needs to pay for health care services before the health plan begins to pay. The deductible may not apply to all services.

Copay means a fixed amount (for example, $20) the patient pays for a covered health care service, such as a physician office visit or prescription.

Coinsurance means the percentage the patient pays for a covered health service (for example, 20% of the bill). This is based on the allowed amount for the service. You pay coinsurance plus any deductibles you owe.

A patient's specific health care plan coverage, including the deductible, copay and coinsurance, varies depending on what plan the patient has. Health plans also have differing networks of hospitals, physicians and other providers that the plan has contracted with. Patients need to contact their health plan for this specific information.

3. What is the difference between charges, cost and reimbursement?
Total Charge is the amount set before any discounts. Hospitals are required by the federal government to utilize uniform charges as the starting point for all bills.

The charges are based on what type of care was provided and can differ from patient to patient for similar services, depending on any complications or treatments provided due to the patient's health.

Cost - For a hospital, it is the total expense incurred to provide the health care. Hospitals have higher costs to provide care than freestanding or retail providers, even for the same type of service. Hospitals are open 24 hours a day, 7 days a week and are prepared to provide care in emergencies. Non-hospital health care providers can choose when to be available and typically would not provide services that would result in losses.

Reimbursement is the amount actually paid to a hospital. Hospitals are paid by health plans and/or patients, but the total amount paid is significantly less than the starting charges.

Medicare pays hospitals much less than the hospital charge and typically less than their total costs.

Medicaid reimbursement is even lower and significantly below actual cost.

Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges.

Patients may also qualify for discounted services based on household income as compared to the Federal Poverty Level. Please visit the Patient Financial Assistance section of the hospital website at www.jch.org or inquire about the financial need assistance program and Illinois Hospital Uninsured Patient Discounts with the Hospital's Patient Financial Counselor for further assistance.

4. How can I use this hospital charge information for comparing prices?
Charge information is not necessarily useful for consumers who are "comparison shopping" between hospitals because the descriptions for a particular service could vary from hospital to hospital and what is included in that description. It is difficult to try to independently compare the charges for a procedure at one facility versus another. An actual procedure is comprised of numerous components from several different departments - room and board, laboratory, other diagnostics, pharmaceuticals, therapies, etc.

A patient who has the specific insurance codes for services requested, available from their physician, can better gauge charge estimates across hospitals. Ask your physician to provide the technical name of the procedure that has been recommended as well as the specific ICD and CPT codes for service.

5. How can I get an estimate for a specific procedure?
If you need an estimate for a specific procedure or operation, please contact the Hospital's Patient Financial Counselor.

Such estimate will be an average charge for the procedure without complications. A physician or physicians make the determination regarding specific care needed based on considerations using the patient's diagnosis, general health condition and many other factors. For example, one individual may require only a one-day hospital stay for a particular procedure, while another may require a two-day stay for the exact same procedure.

Remember that the patient will not pay charges. Rather, the patient with health insurance will only pay the specified deductible, copay and coinsurance amounts established by their health plan. A patient without health insurance or sufficient financial resources may be eligible for significant discounts from charges. Please contact the Hospital's Patient Financial Counselor for further information.

Patient Financial Counselor: 618-498-8326
Hospital Insurance Billing Department: 618-498-8322