YOUR CHARGES AND YOUR BILL

Understanding hospital “charges” can be confusing (see below), and the most accurate way to understand what you will owe for a test or procedure is to request an estimate. This is because your final amount due will differ from any “charges” that are associated with your specific test or procedure. Your actual out of pocket cost will be based on a number of factors, including your insurance, and hospital “charges” are almost always much higher than what you owe.

If you would like an estimate of your out of pocket costs prior to your test or procedure, our Financial Coordinators can easily run an estimate for you. Click here to learn more about requesting an estimate.

Please contact our Patient Financial Coordinator at (330) 971-7597 for a customized estimate of patient responsibility based upon your insurance. Regular business hours are Monday – Friday, 8 a.m. – 4:30 p.m. The Patient Financial Coordinator can also provide more information about the cost of your care.

Charges are not usually what you pay

In compliance with state law, Western Reserve Hospital is providing this price list containing our most common charges for Room and Board, Emergency Department, Operating Room, Physical Therapy, Pain Medicine and other procedures. This publication is available upon request when visiting the hospital.

In compliance with federal law, the information provided here is a comprehensive list of charges, effective January 1, 2019, for the thousands of inpatient and outpatient services or items provided by a hospital.

This list is known as a chargemaster.

This 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. 

Why?

Chargemaster amounts are almost never billed to a patient or received as payment by a hospital. The chargemaster amounts are first billed to a commercial insurance company, Medicare, or Medicaid. Then, those insurers apply their contracted rates – effectively discounting the original “charges” – to the services that are billed.

Hospitals are paid the insurance company’s contract rate, which generally is 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.

Consider an example:

  • A hospital may have listed on its chargemaster a $1,000 cost for a particular service.
  • The patient’s insurance contract rate for that service is, however, only $700.
  • Further, if the patient’s insurance plan indicates the patient is responsible for only 20 percent of the contract rate, the patient would owe $140 ($700 x 20 percent).

This example shows why patients should not consider using the chargemaster as a helpful tool to comparison shop between hospitals or to estimate what health care services are going to cost them out of their own pocket. By simply referring to the chargemaster, the patient in the above example might believe the particular service could cost them $1000 instead of the actual $140 they would be responsible for.

In situations where a patient does not have insurance, a hospital has financial assistance policies that apply these discounts to the amounts charged. More information on our financial assistance policies can be found by contacting Patient Financial Services at (330) 255-3101.