About Pricing Data

Focus on Hospitals allows health care consumers to compare information about the most common inpatient medical procedures and emergency department services at participating hospitals. Hospital pricing and medical billing can be complicated. We hope this site will provide you with more information about how hospital charges relate to what patients actually pay for services.

By using the search feature, users can find hospital charges for a variety of medical services. But, most health care consumers will never pay these rates. These “charges” are more like a sticker price on a car — a starting point that is reduced dramatically for most customers. Insurance companies, Medicare and Medicaid all pay hospitals at rates far below these charges. Those actual amounts vary from one case to the next.

What are hospital charges?

Because every person is different, medical services for procedures might not be the same either. What if you have an allergic reaction? What if it takes a little longer for you to respond to a medicine to treat your condition? That’s why we list the low, median and high charges for each procedure — charges vary depending on the person being treated. And, the range is wide!

When hospitals determine charges for procedures, they consider all services that go into making the procedure possible. That includes the building, availability of emergency services, medical equipment and supplies, staff, and many other things you never see. And, those services are available 24 hours a day, seven days a week, 365 days per year.

Hospitals also know that they have to price services higher than anyone will actually pay so that after negotiation with insurers, they cover their costs. Remember, Medicare and Medicaid decide how much they will pay no matter what the hospital cost is, and commercial insurers want the best deal they can negotiate. The vast majority of hospital “customers” — private insurance companies, Medicare and Medicaid — pay hospitals at rates much lower than hospitals’ posted charges.

How much will I pay?

This site lists hospital “charges,” but the vast majority of people will pay much, much less. To find the most accurate information for you, follow these suggestions.

• If you have insurance: Ask your insurance company about what health care services are covered and what costs you may be expected to pay. This is especially important if you have an elective procedure that is scheduled ahead of time. Start by asking your doctor about the specific name of the procedure, the insurance codes and a list of tests or follow-up care you may receive. Then, ask your health plan for a price estimate. It also is important to ask the insurance company about the network status of the physicians, hospital and other providers that will be part of your care. That includes not only your own doctors, but also additional specialists, like anesthesiologists or radiologists, that may help care for you in the hospital. Also, be sure to ask your insurance company if you need pre-approval or pre-authorization for your procedure, and where you stand in meeting any deductibles or other out-of-pocket costs. In Missouri, commercial insurance companies are required to provide you with the amount of your out-of-pocket expenses for medical procedures when you contact them in advance.
• If you need emergency care: All hospitals are required under federal law to provide emergency care to all individuals, regardless of the person’s insurance status or ability to pay for care. However, those that have insurance coverage or can afford to pay their medical bills will have payment responsibilities.
• If you’re out-of-network: If you have insurance, be aware that not all hospitals and physicians will be part of your insurance network. That’s where the term “out-of-network” comes from. If a hospital or physician is “in network” with your insurance plan, they have agreed to a payment amount for any services. Your share would be part of your copayment or deductible. The best way to find out whether a hospital or physician is in your insurance network is to contact your health plan ahead of time.
• If you don’t have health insurance: Missouri hospitals provide care to all who need it, regardless of their insurance status or ability to pay. That commitment is part of hospitals’ mission. Each hospital has a different program, so ask your hospital’s patient financial services or patient access representative about financial assistance programs for which you may qualify.

A guide from Cover Missouri may help you understand more about how health insurance works.

A guide from the Healthcare Financial Management Association helps consumers understand where to get answers to questions about health care prices, compare prices among providers and manage out-of-pocket costs.