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Pricing 101
Determining hospital prices is tricky. Like buying a new car, hospital prices reflect a “sticker” price. Except, this sticker amount is based on three things:
- The market,
- Insurance and government payments, and
- Cost of service.
Consider in this mix the way that hospitals are reimbursed by government insurers, like Medicare and Medicaid. These insurers pay hospitals a set amount regardless of the price. However, that amount may or may not cover the cost of providing the service. At the same time, commercial insurance companies contract with hospitals to pay a reduced or discounted amount of the charges.
Determining payment
As the patient, your payment is dependent upon your individual insurance plan. Most TriHealth patients carry insurance with one of the following companies.
The portion you are responsible to pay for is often called a copayment, deductible or coinsurance. If you are required by your insurance plan to pay a deductible or percent of allowable charges, the “sticker price” you see is reduced by the amount negotiated by your particular insurance company.
Defining the lingo
Here are a few helpful terms in determining what kind of payment might be required of you as part of your insurance plan.
| Copayment |
A fixed dollar amount listed on your insurance card for a specific type of service, like an emergency room visit, for certain procedures, and for physician office visits. |
| Deductible |
Usually a fixed dollar amount that you must spend before the insurance company begins to make payment. The overall hospital price is reduced by the amount negotiated by their insurance company.
For example, a patient receives an x-ray and has a $50 deductible remaining.
| X-ray price |
= $100 |
| Insurance allowable or discounted amount |
= $ 60
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| Patient pays deductible |
= $ 50
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| Insurance pays |
= $ 10 |
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| Coinsurance |
Usually, the coinsurance is the amount that the patient must pay in addition to the insurance company payment to the hospital The hospital price is reduced by the amount negotiated (allowed) by their insurance company.
For example, a patient receives a x-ray and is expected to pay 20 percent of outpatient allowable charges:
| X-ray price |
= $100 |
| Insurance allowable or discounted amount |
= $ 60 |
| Patient pays 20 percent |
= $ 12 |
| Insurance pays |
= $ 48 |
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Get pricing
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Download price list PDF >
Remember,
your payment is dependent upon your individual insurance plan. However, if you do not have insurance, you may qualify for financial assistance. Learn more >
Source:
http://www.nhpricepoint.org/
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