Hospital Charges -- What Are We Talking About?
As of January 1, 2019, the Centers for Medicare and Medicaid Services (CMS) required that all hospitals post a comprehensive, online list of standard charges for services and goods that the hospital provides to its patient. The list is intended to help you easily access charge information to improve price transparency.
While we fully support efforts to improve pricing transparency, the list of standard charges was only a starting point in determining the costs associated with your health care. By itself, the list is not the most helpful tool for you to comparison-shop between hospitals or to estimate your financial obligation for the healthcare services you receive.
Your out-of-pocket cost for care is determined by:
- the agreed-upon rate that your insurance company pays the hospital for the services provided — which are generally less than the standard charges; and
- the copay, co-insurance or deductible required by your benefit plan.
Individuals without insurance receive a reduced price from the hospital and may also be eligible for financial assistance or charity care.
Therefore, beginning on January 1, 2021, hospitals are also required to make public their standard charges online in two updated ways:
1. A comprehensive machine-readable file that includes all standard charges for all hospital items and services; and
2. A consumer-friendly display of standard charges for ‘shoppable’ services that are grouped with charges for ancillary services that are customarily provided by the hospital. These standard charges must include:
- Discounted cash price: the charge that applies to an individual who pays cash, or cash equivalent, for the shoppable service. If the hospital does not offer a discounted cash price for a shoppable service, the hospital must list its undiscounted gross charge for the shoppable service (and any corresponding ancillary services).
- Payer-specific negotiated charge: the charge that a hospital has negotiated with a third party payer for the shoppable service.
- De-identified minimum negotiated charge: the lowest charge that a hospital has negotiated with all third-party payers for the shoppable service.
- De-identified maximum negotiated charge: the highest charge that a hospital has negotiated with all third-party payers for the shoppable service.
About YOUR Cost
Even when provided with this information, we recognize that trying to estimate your out-of-pocket costs prior to receiving care can be challenging. For nearly all patients, standard charges have little impact on out-of-pocket costs. Typically, patient costs are driven by their specific insurance plan design – with remaining deductible and coinsurance limits being the biggest factors in determining costs. As such, the most effective way to determine potential costs for services is to work with your insurer and our patient financial services staff. They can review your personal situation to give you the most accurate estimate, which can vary based on:
- the complexity of your treatment plan;
- the insurer or payer that will be paying for the healthcare services we deliver;
- the length of time you spend in the hospital;
- additional tests or procedures needed; and
- any other unforeseen conditions or circumstances that arise during your care or recovery
Our staff can be reached at 888-974-1242.
Alternatively, Jefferson has a self-service, online Price Estimator Tool that can be used to generate the approximate out-of-pocket cost for 300+ common services. Please use the following link to access this tool:
The price estimation tool require shoppers to use Chrome, Fire Fox, Edge or Safari browsers.
Machine Readable Files
(Last Updated: 2/21/2021)
Discount Cash Package Price disclaimer: Please note, the discounted cash price is only available for patients who both (i) reside in Pennsylvania, New Jersey or Delaware and (ii) are receiving medically necessary services.
(Internet Explorer Users: please download and save files to open.)
Frequently Asked Questions About the Charge Description Master
What is price transparency and why is it important?
Price transparency is the ability for a healthcare consumer to access provider-specific information on the price of healthcare services, including out-of-pocket costs, regardless of the setting in which those services are delivered.
Why do healthcare consumers need price transparency?
Healthcare consumers need price transparency to:
- help them manage their healthcare costs; and
- inform their healthcare decisions through a better understanding of their financial responsibility.
Why are there differences in charges for the same items and services between hospitals — even within the same health system?
There can be variations, sometimes large ones, in the charges that hospitals set for the same item or service — even within the same health system. This is due to the many factors that go into determining the hospital’s cost of delivering those items and services. Some hospitals have higher cost structures due to the complexity and expense associated with the services they provide (such as trauma, transplant and neonatal intensive care services). Others have higher mission-related costs, such as teaching, research and providing care for low-income populations.
Does the type of health insurance coverage I have impact my costs?
Yes. Your health benefit plan sets your out-of-pocket costs (such as deductibles, co-payments, and co-insurance) for services received at a hospital within its network.
If I am uninsured, do I pay the hospital’s full price charge for items and services I receive?
No. There are various levels of discounts available depending on your income status. Each hospital’s discount program is different. Please check with the Patient Financial Services team to learn more about the discounts available to you.
What is a shoppable service?
A shoppable service is one that can be scheduled by a healthcare consumer in advance. Such services are routinely provided in non-urgent situations that do not require immediate action or attention to the patient, thus allowing patients to price shop and schedule a service at a time that is convenient for them.
What are examples of shoppable services?
Examples of common shoppable services include imaging and laboratory services, medical and surgical procedures, and outpatient clinic visits.