CMS Pricing Transparency
You have reached the section of our website that contains the charges for services we provide within our hospitals. Effective January 1, 2019, the Centers for Medicare and Medicaid (CMS) began requiring hospitals to make a list of standard charges available to the public and keep routinely updated. While Landmark Hospital supports insight into pricing of our hospital services for the benefit of those we serve, it is important for our patients and their families to understand that healthcare billing is complex and the standard charges listed reflects the amount generally billed by the hospital and may not be a relevant comparison for estimating what costs you may incur during an episode of care. In general, there are many different factors that determine the amount paid such as individual insurance coverage, insurance policy provisions, services that are provided in our hospital by other healthcare providers who may separately bill the patient, and the fact that each patient’s case is unique based on their medical condition.
Because hospital billing can be complicated and difficult to understand – even for those with experience in the matter – we have compiled the following frequently asked questions as well as including a consumer guide to healthcare prices published by Healthcare Financial Management Association (HFMA):
“Pricing Transparency” is the term used by CMS to describe initiatives in the healthcare industry to provide pricing information to consumers. Price transparency is one means of providing the average or common price information on services provided by hospitals.
A Chargemaster is a comprehensive list of standard charges for each inpatient and outpatient service or item provided by a hospital (i.e. 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 and can change at any time and services and items may be added or deleted.
Chargemaster amounts are almost never billed to a patient or received as payment by a hospital, rather they are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted rates to the services that are billed, often times as a bundled payment. In situations where a patient does not have insurance, Landmark Hospitals have financial assistance policies to assist or you may be eligible for Medicaid coverage.
Health insurance companies contract with hospitals to care for their customers and are paid the insurance company’s contract rate, which is generally 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 plan indicates the patient is responsible for 20% of the contract rate, the patient would owe $140 (i.e. $700 X 20%).
Chargemaster information is not particularly helpful for patients to estimate what their health care services are going to cost them out of their own pockets. The charge listed in the Chargemaster is generally not the amount a patient will pay. If you have health insurance, the amount you will be billed and expected to pay for your services depends on your specific health insurance coverage and your insurance company’s contract with the hospital.
The hospital’s Chargemaster generally does not include charges for services provided by the doctor(s) or other specialists who treat you while you are at the hospital. You may receive separate bills from the hospital and the doctors involved in your care. The following is a partial list of healthcare provider who may bill you separately:
- A surgeon who performs your procedure or surgery
- The anesthesiologist who works with the surgeon
- A specialist who is consulted during your hospitalization (i.e. infectious disease, pulmonologist, etc.)
- The radiologist who reads your x-ray or other imaging tests
- Laboratory/Pathology testing
- Contact your insurance company to understand all of the factors affecting your financial responsibility.
- Numerous factors such as the type of plan, co-pay, co-insurance, deductible, out-of-pocket maximums, provider network and other limitations will factor into your financial responsibility to the hospital.
- The prices reflected on this site do not include any negotiated discounts between your insurance company and the hospital.
- Medicare has many different parts, and not everyone has the same type of Medicare coverage. Medicare will pay for many of your healthcare expenses, but not all of them.
- Special rules apply if you have employer group insurance coverage through your job or a spouse’s job.
- If you have a supplemental health insurance policy, it may cover some costs that Medicare does not cover.
- The best way to be sure of what your Medicare plan covers is to call 1-800-MEDICARE, or visit the website at www.medicare.gov.
- Contact your local Medicaid office, or visit you state department of health to determine all of the factors affecting your financial responsibility; generally, Medicaid recipients are not responsible for any portion of the bill.
Landmark Hospital of Athens, Georgia
Landmark Hospital of Cape Girardeau, Missouri
Landmark Hospital of Columbia, Missouri
Landmark Rehabilitation Hospital of Columbia, Missouri
Landmark Hospital of Joplin, Missouri
Landmark Hospital of Naples, Florida
Landmark Hospital of Savannah, Georgia
The information provided on the Chargemaster is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital. It is not a helpful tool for patients to comparison shop between hospitals or to estimate what health care services are going to cost them out of their own pocket.
Although we update quarterly, the prices on the website may not reflect the most current charge items of this hospital as additions and changes are frequently made to the list therefore, these charges may not be representative of the charges you will receive on your bill for services provided by our hospital.