All patients should familiarize themselves with the terms of their insurance coverage. This will help you understand the hospital’s billing procedures and charges. If there is a question about your insurance coverage, a member of the Patient Accounts Department will contact you or a member of your family while you are here. Information is needed in order to process your claims.
If You Have Health Insurance
We will need a copy of your identification card. We also may need the insurance forms, which are supplied by your employer or the insurance company. You will be asked to assign benefits from the insurance company directly to the hospital.
If You Are a Member of an HMO or PPO
Your plan may have special requirements, such as a second surgical opinion or pre-certification for certain tests or procedures. It is your responsibility to make sure the requirements of your plan have been met. If your plan’s requirements are not followed, you may be financially responsible for all or part of the services rendered in the hospital. Some physician specialists may not participate in your health care plan and their services may not be covered.
If You Are Covered by Medicare/Medicaid
We will need a copy of your Medicare card to verify eligibility and process your Medicare claim. You should be aware that the Medicare program specifically excludes payment for certain items and services, such as cosmetic surgery, some oral surgery procedures, personal comfort items, hearing evaluations and others. Deductibles and co-payments also are the responsibility of the patient.
We will need a copy of your Medicaid card. Medicaid also has payment limitations on a number of services and items. Medicaid does not pay for the cost of a private room unless medically necessary.
If You Have No Insurance
A representative from the Accounting Department will discuss financial arrangements with you. A hospital representative who is a representative of the Division of Family Services is also available to assist you in applying for Medicaid or other government assistance programs.
Your Hospital Bill
The hospital is responsible for submitting bills to your insurance company and will do everything possible to expedite your claim. But you should remember that your policy is a contract between you and your insurance company and you have the final responsibility for payment of your hospital bill. We have several payment options available to assist you in paying your bill.
Your bill reflects all of the services you receive during your stay. Charges fall into two categories: a basic daily rate, which includes your room, meals, nursing care, housekeeping, telephone and television; and charges for special services which include items your physician orders for you, such as X-rays or laboratory tests.
If you have certain tests or treatments in the hospital, you may receive bills from physicians you did not see in person. These bills are for professional services rendered by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, anesthesiologists and other specialists perform these services and are required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you receive from them.
What is the difference between a charge and an allowable charge?
The charge is the amount billed by the provider for the specific service. An allowable charge is an agreed upon amount that your health insurance company will actually pay the provider for the specific service. This can affect your out-of-pocket costs. You will need to check with your health insurance company to see if and what you would owe for your deductible, co-pay, or co-insurance.
What is a Provider-Based or Hospital-Based Outpatient Clinic?
Hospital/clinic charge information
Average DRG Pricing (.xlsx)
CDM Pricing (.xlsx)
Provider Based Clinics (.xlsx)
Provider-Based or Hospital-Based Outpatient Clinics FAQs
Detail Charge Information
For detailed charge information or an estimate of charges for a particular procedure, please call 662-459-2742.