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.
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).
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:
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:
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.
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:
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.
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.
Anderson Regional Health System offers a wide range of medical services, including cancer, cardiac, pediatric, surgical, and trauma care. Our healthcare professionals are committed to improving the lives of those we serve.