Presence Health

Federal regulations require hospitals to maintain a catalog of tens of thousands of procedure codes and list prices — and to uniformly apply the full list price (hereafter referred to as a charge) to all patients who receive a specific service.

To help AMITA Health patients better understand these charges (and how they might affect their actual payment), we have provided a full list of standard charges for each of our hospitals below.

 

Charges vs. Payments — What’s the Difference?

A hospital charge is a federally-required maximum list price for an item or service that does not reflect any negotiated discount. A payment is the amount you actually have to pay.

Keep in mind that almost no one pays the full hospital charge. Private health insurance plans negotiate significant discounts. Medicare and Medicaid reimburse hospitals using complex formulas that often pay less than the actual cost. Uninsured patients often qualify for financial assistance, including free care. In short, the standard charge will almost certainly not be the final total on your bill.

 

What Factors Impact Cost?

Costs can vary by hospital, community and region, but they are generally affected by the following:

  • The individual services provided to the patient
  • Care for patients who are unable to pay
  • Medicare and Medicaid underpayments
  • The costs of maintaining 24/7 hospital readiness

 Addition, hospitals that provide vital specialized services (i.e., trauma, burn units, etc.) or train doctors and other healthcare professionals operate under a different cost structure and pricing.

 

Why Is It So Hard to Calculate Costs?

Many factors make it difficult to estimate healthcare costs. First, every patient’s needs are unique, and doctors do not decide what services they need until after an examination. Second, providers are not aware of a patient’s current health benefits plan status, such as how much they’ve already spent towards their deductible. Finally, legal barriers restrict information on negotiated rates. Add in the fact that health plans do not reveal what amount they will reimburse for out-of-network doctors and you have an extremely complex system that makes pricing estimates a challenge.

Download Hospital Standard Charges

 

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