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.
For patients who have little or no health insurance, Western Reserve Hospital offers a variety of services. Please contact our Patient Financial Coordinator at 330-971-7597 for more information on our charity care program or for an uninsured discount. Western Reserve Hospital also provides support to patients who need help determining their eligibility for Medicaid and other financial support services.
Western Reserve Hospital believes that price transparency, and more importantly, out-of-pocket expectation, is a benefit to our patients and an important part of health care decisions for patients and their families.
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.
The link below is intended to offer users an estimator tool for commonly provided healthcare services pursuant to the CMS Price Transparency Final Rule (84 FR 65524) which is effective January 1, 2021. The pricing is only an estimate and cannot be relied upon as a quote or guarantee of actual charges. The link also provides access to download a machine readable file of the standard charges and negotiated rate disclosures required by the federal government.
Charges Are Not Usually What You Pay
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. In addition, Western Reserve Hospital offers substantial discounts for patients with no insurance who desire to pay cash upfront in advance of their procedure. More information on our financial assistance policies can be found by contacting Patient Financial Services at (330) 255-3101.