Healthcare Charges FAQ’s
Frequently Asked Questions:
- How much will I actually have to pay out of my pocket?
- A patient with health insurance needs to pay the deductible, copay and/or coinsurance set by their health plan.
The financial obligations could differ depending on whether the hospital or physicians are “out-of-network”, meaning the health plan does not have a contract with them. Contact your insurance company to understand what your financial obligations will be.
- A patient without health insurance will discuss the options available for financial assistance that could include either complete write-off of the charges or substantial reduction in accordance with the Illinois Hospital Uninsured Patient Discount Act and Memorial Medical Center’s financial assistance program.
Please contact the Patient Services Representatives 217-876-3785 to obtain further information about the discounts available.
Health insurance plan pays: Health plans such as Medicare, Medicaid, workers compensation, commercial health insurance, etc. do not pay charges; instead they pay a set price that has been predetermined or negotiated in advance. The patient only pays the out-of-pocket amounts set by the health plan.
If you need help understanding your health care bill, please contact the Patient Services Representatives in Patient Financial Services 217-876-3785 .
- What do the following health insurance terms mean?
Deductible means the amount the patient needs to pay for health care services before the health plan begins to pay. The deductible may not apply to all services.
Copay means a fixed amount (for example, $20) the patient pays for a covered health care service, such as a physician office visit or prescription.
Coinsurance means the percentage the patient pays for a covered health service (for example, 20% of the bill). This is based on the allowed amount for the service. You pay coinsurance plus any deductibles you owe.
The specifics of the patient’s health plan coverage, including the deductible, copay and coinsurance, vary depending on what health plan the patient has. Health plans also have differing networks of hospitals, physicians and other providers the plan has contracted with. Patients need to contact their health plan for this specific information.
- What is the difference between charges, cost and price?
Total Charge is the amount set before any discounts. Hospitals are required by the federal government to utilize uniform charges as the starting point for all bills.
The charges are based on what type of care was provided and can differ from patient to patient for the same service depending on any complications or different treatment provided due to the patient’s health.
Cost – For a hospital, it is the total expense incurred to provide the health care. Hospitals have higher costs to provide care than freestanding or retail providers, even for the same type of service. This is because a hospital is open 24 hours a day, 7 days a week and needs to have available everything necessary to cover any and all emergencies. Non-hospital health care providers can choose when to be available and typically would not provide services that would result in losses. A hospital’s cost of services can vary depending on additional factors such as:
the types of services it provides since many vital services are provided at a loss such as trauma, burn, neonatal, psychiatric and others;
providing medical education programs to train physicians, nurses and other health care professionals, again provided at a loss;
some hospitals consistently treat patients with significantly higher levels of illness, yet payment doesn’t cover;
some hospitals have disproportionately high numbers of patients who are on public assistance or uninsured and unable to pay much if anything toward the cost of their care.
Total Price is the amount actually paid to a hospital. Hospitals are paid by health plans and/or patients, but the total amount paid is significantly less than the starting charges.
- Medicare and Medicaid pay hospitals according to a set fee schedule depending on the service provided, much less than the hospital charge and actually less than their costs.
- Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges.
- How can I use this hospital charge information for comparing prices?
Charge information is not necessarily useful for consumers who are “comparison shopping” between hospitals because the descriptions for a particular service could vary from hospital to hospital as well as what is included in that description. It is difficult to try to independently compare the charges for a procedure at one facility vs. another. An actual procedure is comprised of numerous components from several different departments — room and board, laboratory, other diagnostics, pharmaceuticals, therapies, etc.
A patient who has the specific insurance codes for services requested, available from their physician, can better gauge charge estimates across hospitals. Ask your physician to provide the technical name of the procedure that has been recommended as well as the specific ICD and CPT codes for service.
- How can I get an estimate for a specific procedure?
If you need an estimate for a specific procedure or operation, please contact Decision Support at 217-876-3785 .
Such estimate will be an average charge for the procedure without complications. It is not a quote or a guarantee of what the charges will be for a specific patient’s care. A physician or physicians make the determination regarding specific care needed based on considerations using the patient’s diagnosis, general health condition and many other factors. For example, one individual may require only a one-day hospital stay for a particular procedure, while another may require a two-day stay for the exact same procedure. This charge information will not include the professional services provided by a physician, surgeon, radiologist, anesthesiologist, pathologist, advanced practice nurse or other independent practitioners.
Remember that the patient will not pay charges; rather the patient with health insurance will only pay the specified deductible, copay and coinsurance amounts established by their health plan. A patient without health insurance will be eligible for significant discounts from charges. Please contact the Patient Financial Services department 217-876-3785 for further information.
- If a patient has health insurance, significant discounts have already been obtained by the insurance company and the patient only needs to pay the deductible, copay and/or coinsurance. Patients should contact their health plan directly for their specific financial obligations that aren’t reimbursed by insurance.
- If a patient does not have health insurance, significant discounts are available that could result in either the care being free or at a greatly reduced price. Contacting the Patient Financial Services office 217-876-3785 can help determine which discounts can be applied.
- Patients will likely receive separate bills for the physicians and other professionals who provided treatment. These physicians may not be participating providers in the same insurance plans and networks as the hospital. As such, there may be greater patient financial responsibility for these services which are not under contract with the health plan.
- An important component for choosing a health care provider is determining quality of care. Your doctor can be a helpful resource in choosing where to obtain care. Further Medicare hospital-specific quality outcome measures are located on Hospital Compare.
- A helpful document for further information regarding hospital prices is the Healthcare Financial Management Association’s Understanding Healthcare Prices: A Consumer Guide.
- To compare hospital median charges for nearly 50 major diagnoses, quality and patient satisfaction metrics in Illinois, go to the Illinois Hospital Report Card website.