Important Information on Pricing and Fee Schedule
We are committed to delivering high quality healthcare to our patients and the communities in which we serve. It is within this goal, we fully support and comply with price transparency requirements. Please find below our hospital charge description master (CDM), also referred to as a CDM or a fee schedule. If you have any questions regarding a listed charge, call us at the phone number on your statement. We strive to respond to all inquiries within 24 hours (business days or business hours) from the date of the inquiry. We have also provided some details to assist our patients, and consumers in understanding the difference between a billable or gross charge, and how insurers ultimately reimburse hospital services.
Hospital Billed Charges and Patient Share
Emergency Hospital Systems would like to remind our patients to kindly take into consideration that patient out of pocket costs and fees will vary. Some variables include a patient’s health plan benefits, as well as coverage. If you are a patient, the amount of a single charge is but only one indicator of the services we provide. We work closely with patient insurers to identify the estimated out of pocket patient’s share for elective services. For emergency care, we are prohibited in providing full estimates until the patient is deemed medically stable due to federal laws prohibiting line by line detailing hospital pricing while the condition is not stable. We work with our insured patients on a case by case basis to assist in identifying programs which allow for a discount. Our single focus remains on delivering high quality healthcare services which are provided in a safe manner. Our overall important goal is to satisfy our patients and consumers.
Charge Description Master (CDM) Construct, How to Interpret the Charge Master
- We charge all payers agnostically; therefore, all patients are charged the same amount listed in the CDM, regardless of their ability to pay.
- We follow all Uniform billing guidelines, including but not limited to using current CPT-4 codes and using ICD-10 coding classification of diseases and illnesses.
- The charges listed in the CDM are not the actual expected reimbursement from patients nor insurance companies. For uninsured patients, we will work with the patient and guarantor after a bill to determine uninsured discount. These discounts are based on the federal poverty guidelines. Our method for screening these programs is via a financial application which the patient or guarantor may request after initial billing.
o Reimbursement from our payers vary, and insurers/payers end up paying different amounts than the listed price in the CDM/fee schedule.
- Emergency Hospital Systems charges are structured based on frequent reviews (minimum of yearly review) of peer hospitals who are in a similar economic area, similar services, and mark-up or inflation is also calculated based on our supplier suggested list price; these are the primary factors on how we set our price.
- The amount we frequently receive in payment is frequently far less than the price appearing in the CDM fee schedule given payers often negotiate discounts with us.
- The size of the discount and how it is determined varies by payer. Federal and State payers utilize their own set fee schedules which are based on factors such as local wage, cost of living, and cost of care to determine their payment to the provider.
- For emergency services, we follow the Emergency Medical Treatment & Labor Act (EMTALA) before reviewing patient’s ability to pay or securing any financial information. Due to EMTALA requirements, providers are not permitted to breakdown financial prices or estimates until the patient is deemed medically stable. EMTALA focuses on stabilizing a life-threatening medical condition, and not the patients’ ability to pay, or identification of health coverage, or uninsured status. The financial aspect of the service for emergent care is asked after the patient is deemed medically stable.
We look forward to delivering high quality care to our communities. We hope you find these tools helpful. Thank You.