Knowing the price you can expect to pay for health care is important, but it’s also difficult to estimate. Mount Carmel makes it easier by providing a price list for common types of care and making financial counselors available every weekday to help you better understand the cost of your care and what we can do to help you manage it.
For relatively simple services like mammograms or x-rays, you can usually get a good cost estimate up front. However, when it comes to estimating the cost of more complex care like surgery or a hospital stay, it’s difficult to give an accurate estimate up front. That’s because it's hard to tell in advance how quickly you’ll respond to a treatment, how long it will take you to heal or whether the situation turns out to be more complicated than originally thought.
Our financial counselors are happy to assist you in estimating your healthcare costs. They can look at your insurance plan and let you know how much will be covered and estimate what you will have to pay out-of-pocket. They can explain what the standard cost will be and also what might cause the cost to increase. You can reach our financial counselors at 614-234-6074 weekdays between 8:30 a.m. and 5:30 p.m.
If you’re having a surgical procedure and want to know the estimated cost up front, here are some things you can get from your physician to help us accurately estimate your costs:
- The technical name of the procedure and the ICD-9 or ICD-10 diagnosis code
- Any tests you will need before surgery (e.g., a blood test or imaging tests)
- Other physicians who will be involved in your care (e.g., a pathologist, anesthesiologist or radiologist)
- Whether you will have general anesthesia
- Whether you will need to go to a rehab facility after discharge
- Whether you need home care
- Whether you need home medical equipment or devices and what they are
- What follow up medications you will need
- What possible complications might impact the cost of the procedure
If you have insurance, the amount you will have to pay out of pocket will depend on your deductible, copayment, coinsurance and out-of-pocket maximum. Here are some common out-of-pocket costs you may need to consider:
- Covered Services – Not all services are covered by all health insurance plans, so make sure you check with your plan ahead of time to see if the service you need is covered.
- Deductible – Your deductible is the dollar amount of health care services that your health plan requires you to pay for before the health plan begins to pay. For example, if your deductible is $2,500, you must pay for the first $2,500 in care you receive and then your health plan will start to pay its share based on your coinsurance amount.
- Coinsurance -- Coinsurance is the percent of healthcare costs you are responsible for after you have met your deductible. For example, if your coinsurance is 20% and you have already met your deductible, if you get a bill for $150 from a physician, your health plan requires that you pay 20% of that $150 bill ($30).
- Copayment – Some health plans have copayments for certain services, which are fixed amounts that you must pay at the time of service. For example, if you have a $25 physician office visit copayment, then you will pay $25 for each visit you make to the doctor’s office.
- Allowable amount – An allowable amount is the maximum amount your health plan will pay to a provider for a service. It’s also called a "negotiated rate" or "eligible expense."
- Network providers – Network providers are hospitals, facilities and physicians who have contracted with your health plan to provide services at an agreed-upon rate. Network providers must accept payment for the agreed rate and cannot bill patients for any charges beyond the agreed-upon rate.
- Out-of-network providers – These are providers who have not contracted with your health plan. You will most likely pay more if you use an out-of-network provider, as many health plans have higher co-pays, deductibles and coinsurance for out-of-network providers and some plans may not cover out-of-network care at all. Costs can add up quickly, so be sure and find out if the providers you’re planning to use are in your network. You may decide that you want to go out of network anyway, but it's good to know in advance what it might cost you.
- Pre-Approval – Many insurance plans require pre-approval of certain services, such as CT or MRI scans. If you receive care without obtaining a pre-approval, your insurance company may not cover your claims. If you’re not sure whether pre-approval is required, call your health plan.
- Emergency Care – If you go to an emergency department that is not in your health plan's network and it charges more than what your health plan pays, you may be billed by the ED for the difference. This is called balance billing. It's a good idea to know in advance about your coverage for out-of-network emergency care so you can be better prepared when an emergency arises.
In compliance with state law, Mount Carmel is happy to provide a price list with our charges for room and board, emergency department care, operating room usage, delivery, physical therapy and other procedures. The hospital's charges are the same for all patients, but your responsibility may vary depending on payment plans negotiated with your health insurer. If you’re uninsured or underinsured, please consult with our admitting and billing staff to see if you qualify for discounts.
Prices are correct as of July 1, 2016.