Hospital Based Charges | Anderson Regional Health System

Understanding Hospital Chargemasters

Hospital Chargemasters 101

Learn about hospital chargemasters, how they work, and what they mean for your healthcare costs. Find out how insurance affects your charges and how to get financial assistance if needed. Get expert help and answers to your questions today.

Chargemasters list hospital charges for services and items

Insurance and contracted rates affect patient charges

Factors that can affect total charges for an individual

Separate charges may come from doctors and other providers

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Hospital Based Charges

What is a Chargemaster?

A Chargemaster is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital – each test, exam, surgical procedure, room charge, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a Chargemaster contains thousands of services and related charges.

Chargemaster amounts are almost never billed to a patient or received as payment by a hospital. The Chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted rates to the services that are billed. In situations where a patient does not have insurance, our hospital has financial assistance policies that apply discounts to the amounts charged. More information on our financial assistance policies can be found here.

Health insurance companies contract with hospitals to care for their customers. Hospitals are paid the insurance company’s contract rate, which generally is significantly less than the amount listed on the Chargemaster. The insurance company’s contract rate, not the Chargemaster, is the basis for determining the patient’s actual out of pocket costs. As an example, a hospital may charge $1,000 for a particular service, while the insurer’s contract rate may be $700. If the patient’s insurance plan indicates the patient is responsible for 20 percent of the contract rate, the patient would owe $140 ($700 x 20 percent).

Are Charges the Same for Every Patient?

The list of charges is the same for all patients. However, the total charges for an individual patient often vary from one patient to another for a number of reasons, including:

How long it takes to perform the service or how long it takes you to recover in the hospital
Whether the service or procedure you receive is more or less difficult than expected
What kinds of medication you require
Whether you experience complications and need additional treatment
Other health conditions you may have that may affect your care

Is the Charge the Same as What the Patient Pays?

Chargemaster information is not particularly helpful for patients to estimate what health care services are going to cost them out of their own pocket. The charge listed in the Chargemaster is generally not the amount a patient will pay. If you have health insurance, the amount you will be billed and expected to pay for your services depends on your specific health insurance coverage and your insurance company’s contract with the hospital.

If you do not have health insurance, you may be eligible for reduced costs under the hospital’s financial assistance policy, or you may be eligible for Medicaid coverage.

What is Not Included in the Chargemaster List?

The hospital’s Chargemaster does not include charges for services provided by the doctor (or doctors) who treat you while you are at the hospital. You may receive separate bills from the hospital and the doctors involved in your care.

Here is a partial list of health care providers who may bill you separately:

Your personal doctor, if he/she sees you in the hospital
The Emergency Room physician
The surgeon who performs your procedure
The hospitalist who may see you in the hospital
The anesthesiologist and certified nurse anesthetist who works with the surgeon
The radiologist who reads your x-rays or other imaging
Other doctors who may be consulted by your doctor during your time in the hospital
Laboratory testing

Where Can I Find More Information about Hospital Costs?

If you would like more information about the Chargemaster, what your care will cost, or the hospital’s financial assistance policy, please contact Patient Financial Services 601.553.6850.

Please consult with your insurance provider to understand your insurance coverage, which charges will be covered, how much you will be billed, information on deductibles, and your expected out-of-pocket responsibility.

A consumer guide to avoiding surprise medical bills jointly prepared by the American Hospital Association, Healthcare Financial Management Association and America’s Health Insurance Plans is also a good resource.

Pricing Transparency

Researching medical costs can be complicated. At Anderson Regional Health System, we're making it easier by offering two unique tools to help you get an accurate estimate of your out-of-pocket expenses for a variety of procedures and services. Whether you have insurance or not, you can get a customized estimate for your care at Anderson Regional Health System.

Patient Cost Estimator

Our new Patient Cost Estimator is a Centers for Medicare and Medicaid Services (CMS)-compliant calculating tool that uses our electronic medical records database to give you an estimate of your out-of-pocket costs based on your location, procedure or service, and your specific insurance plan. The Patient Cost Estimator provides costs for a select range of outpatient or inpatient procedures to allow you to compare our costs to other facilities.

About CMS

The Centers for Medicare and Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS) that administers the nation’s major healthcare programs including Medicare, Medicaid, and CHIP, and the state and federal health insurance marketplaces. The agency aims to provide a healthcare system with better care, access to coverage, and improved health. To further that mission, starting January 1, 2021, each hospital operating in the United States is required to provide clear, accessible pricing information online about the procedures and services they provide in two formats:

In a display of shoppable services in a consumer-friendly format
As a comprehensive machine-readable file listing all items and services

Our new Patient Cost Estimator helps us meet the first requirement of presenting our patients with a consumer-friendly format to compare prices across hospitals and estimate their out-of-pocket cost before going to the hospital.

MACHINE READABLE FILE

This file may not represent all services offered by the provider; if you are unable to find a specific service, please call us at 601-553-6850.

1. Codes not listed or listed without an allowable could be considered non-reimbursable based on individual payer payment methodology.

2. Procedure based codes could be based upon Operating Room time, which varies based on the operative session. Operating Room Major or Minor will be billed for the first hour with additional 15 minute increments if required.

Click Here To View Our Patient Cost Estimator

Disclaimer: Estimates created by Patient Cost Estimator are not guaranteed, and may change due to a number of other factors.

Understanding Hospital "Charges"

A hospital "charge" is not the same as "expected payment." "Charge" is the amount billed for a service. In the vast majority of cases, hospitals are paid considerably less than the billed amount. Because each person's case is different based on that patient's medical condition, a given patient's charge will not necessarily be the same as the average or median charge. Furthermore, the actual amount paid by a patient will depend on that patient's insurance coverage.