The law requires hospitals to set uniform charges (the amount set before any discount) as the starting point for all bills, which is then adjusted by the negotiated insurance rates. The starting list of charges is the same for every patient, but the charges may vary by the patient even though a similar procedure was performed. This may be due to the patient’s medical condition, time spent in surgery or recovery, complications requiring unanticipated procedures, medications needed, etc.
This information allows healthcare consumers to receive basic, facility-specific information about their services, charges, and insurance reimbursement, which is listed by the payer in the columns of the file below. Anderson Hospital has posted this list of standard charges for inpatient and outpatient services, including the chargemaster and DRG/CPT service packages. The payer rate information shows individual item and service reimbursement and does not reflect true out-of-pocket costs.
The file below is likely not helpful for a patient to know their financial obligation or to shop between hospitals. For more information about the charge for your medical care and to obtain an estimate over the phone, please contact our Financial Counselor staff at 618.391.6920.
When viewing the file, please scroll down the spreadsheet to view all Line Types, i.e., CPT, DRGs, and move across to view all payers included in the file. Please note that a blank may not indicate that the data is missing. You may need to scroll up or down on the spreadsheet to identify the data you are searching for, such as the CPT/DRG code.
The content of these files is subject to change.
The patient pays:
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. A patient without health insurance will discuss available financial assistance options that could include either a complete write-off or a substantial reduction of the charges per the Illinois Hospital Uninsured Patient Discount Act and the hospital’s financial assistance program. Please contact our financial counselor at 618.391.6920 for further information about the available discounts.
Health insurance pays:
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. If you need help understanding your healthcare bill, please call 1.877.444.6382.
A deductible is the amount the patient needs to pay for healthcare services before the health plan begins to pay. The deductible may not apply to all services.
A copay is a fixed amount (e.g., $20) the patient pays for a covered healthcare service, such as a physician’s office visit or prescription.
Coinsurance is the percentage the patient pays for a covered health service (e.g., 20% of the bill). This is based on the allowed amount for the service. You pay coinsurance plus any deductibles you owe.
The 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 different treatment provided due to the patient’s health.
The cost (for a hospital) it is the total expense incurred to provide the healthcare. Hospitals have higher costs to provide care than freestanding or retail providers, even for the same type of service. This is because a hospital is open 24 hours a day, 7 days a week, and must have everything available to cover any and all emergencies. Non-hospital healthcare providers can choose when to be available and typically would not provide services that would result in losses. A hospital’s cost of services can vary depending on additional factors such as:
- Types of services it provides, since many vital services are provided at a loss, such as trauma, burn, neonatal, psychiatric, and others;
- Providing medical education programs to train physicians, nurses, and other healthcare professionals – again provided at a loss;
- More patients with significantly higher levels of illness, yet payment doesn’t cover them;
- A disproportionately high number of patients are on public assistance or uninsured and unable to pay much, if anything, toward the cost of their care.
The total price 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.
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 comprises numerous components from several departments – room and board, laboratory, other diagnostics, pharmaceuticals, therapies, etc.
Insurance rate information included in the file above is based on negotiated rates at the individual charge, CPT, and DRG level and does not account for the full reimbursement methodology in the payer contracts, including multiple procedure discounts, packaged case rates, or separate rates for outlier cases.
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.
If you need an estimate for a specific procedure or operation, please contact the Patient Financial Counselor Office at 618.391.6920 or use our Price Estimator Tool.
The estimate will be an average charge for the procedure without complications. A physician or physicians makes 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 same procedure due to an underlying medical condition.
Remember, patients with health insurance will only pay the specified deductible, copay, and coinsurance amounts established by their health plan. Patients without health insurance or sufficient financial resources may be eligible for significant discounts from charges.