As of January 1, 2019 standard charges are being published to meet a recent Centers for Medicare & Medicaid Services (CMS) requirement and do not represent a patient’s out of pocket cost. The Affordable Care Act (ACA) included a requirement for hospitals nationwide to establish, update and make public a list of their standard charges for all items and services provided to patients, including for Diagnosis Related Groups (DRG). This information is to be made available each year.
The 2019 Inpatient Prospective Payment Systems (IPPS) final rule, effective January 1, 2019, revised this requirement to require the Standard Charge List (chargemaster) information to be made available to the public via the internet in “machine-readable” format. A machine-readable format is one that can be automatically read and processed by a computer, such as CSV, XML, etc.
The Standard Charge List (chargemaster) is not a useful tool for consumers who are comparison shopping between hospitals.
Pine Rest is committed to increased transparency around healthcare costs, including price information for patients. We share cost information with patients every day. The best way for any patient to get meaningful price information is to contact the hospital with their specific treatment needs. Every patient, and every patient’s needs and complications, is different and requires individual attention.
Healthcare billing, costs and charges are very complex. Pine Rest recognizes that more needs to be done to simplify the billing process for patients.
Because of widespread variation in health insurance coverage, it is difficult for hospitals to provide patient-specific out-of-pocket cost information without access to very detailed information about a patient’s health insurance coverage. Pine Rest employs financial counselors, patient advocates and other resources to help our patients understand their unique financial obligations. We encourage patients to reach out and ask detailed financial questions – especially before scheduled services. The hospital’s financial counselors can review options for charity care, payment plans, discounts and more.
Patients should not try to determine specific out-of-pocket costs for a particular service based on a Standard Charge List. If a person has health insurance, they should first turn to their own insurance company for co-pay, coinsurance and deductible information. If uninsured, they should contact the hospital’s financial counselors to discuss their personal treatment needs and get an estimated cost of care.
In situations where a patient does not have insurance, patients may be eligible for free or reduced-cost healthcare services through various state public assistance programs like the Healthy Michigan plan, as well as the hospital financial assistance programs.
Hospital costs for patients vary for many reasons.
- Every patient’s case is unique and requires varying levels of care and specific caregivers making no two patient experiences, even for the same services, the same.
- The price a patient sees on their hospital bill reflects not just the specific care team who treated them, but also overall operational costs that keep the hospital running 24 hours a day, 365 days a year.
- Each hospital’s cost and charge structure vary for a variety of reasons including patient complexity; types of services offered; local labor cost; supply and equipment cost; buildings, utility, and maintenance cost; community service programs offered; and other factors.
- Hospitals provide services to meet individual patient needs 24/7/365, provide free or discounted care to low-income patients, and are paid less than cost for services provided to patients covered by governmental insurance programs such as Medicare and Medicaid.
More information on our financial assistance policies can be found at www.pinerest.org/financial-assistance or individuals with questions may contact Pine Rest Financial Services at 616.455.5019.