Did you know…
- Hospitals of all sizes and locations have varying treatments, procedures, costs and quality ratings. Consider all of these factors when choosing which hospital is right for you.
- Data is displayed for the 100 most common diagnoses and procedures admitted to Missouri hospitals. If you can’t find what you’re looking for, contact a hospital to inquire about your options.
- Every person is unique and can face a varying range of complications that affect cost, which is why you’ll see a charge range on your results page.
- A hospital “charge” is not the same as “expected payment.” “Charge” is the amount billed for a service. In the vast majority of cases, hospitals are paid considerably less than the billed amount. Because each person’s case is different based on that patient’s medical condition, a given patient’s charge will not necessarily be the same as the average or median charge. Furthermore, the actual amount paid by a patient will depend on that patient’s insurance coverage.
- To learn more about how charges vary between hospitals contact your insurer to learn who is in your network and what your costs will be.
- These data include information comparing the charges for the 100 most common inpatient services.
- Hospital billing is complex and based on many factors such as staffing, equipment, maintenance costs and the differences in care needed by each patient. Every patient’s case is special and requires different levels of care. Hospitals are prepared with doctors, nurses and high tech equipment 24/7 for illness or injury from a broken bone to a major accident.
- Every insurer, whether Medicare, Medicaid or commercial, pays the hospital differently. If you have Medicare or Medicaid, the government sets the rates for how much is covered. Like commercial insurance, there may be some out-of-pocket costs.
- Medicare is a health insurance program for people age 65 or older or under 65 with certain disabilities or conditions. For Medicare, hospitals generally receive payment of only 86 cents for every dollar of actual cost of providing care. (Source: American Hospital Association)
- Medicaid is a joint federal and state program that helps with medical costs for people with low incomes. For Medicaid, hospitals generally receive payment of only 89 cents for every dollar of actual cost of providing care. (Source: American Hospital Association)
- If you have commercial insurance, insurers negotiate payment rates with hospitals. These rates can differ among companies, and demands for discounts by commercial insurance companies create further complexity for hospitals and patients to determine the true cost of any given procedure.
- Commercial insurers do not pay full hospital charges. Numerous factors, such as the type of plan, co-pay amount, co-insurance amount, deductible, out-of-pocket maximums and other limitations will affect the individual’s financial responsibility to a hospital. Therefore, it is crucial that you begin by talking to your insurance company to understand all of the factors affecting your financial responsibility.
- Self-payment is when a patient pays for a health-related service when they don’t have insurance to cover their medical treatment or surgery. Currently about 173,000 adults in Missouri don’t have insurance.
- For patients who do not have insurance, hospitals typically have financial assistance programs for patients who qualify. Contact your hospital to determine if you qualify for any programs they may offer.
What data is included in the Quality Transparency Initiative?
There are 23 measures included for consumers to review quality of care. These measures are categorized into four areas: managing chronic diseases, reducing readmissions, preventing infections and reducing harm. The information displayed is collected from patient discharge records or abstracted from hospital records. Some hospitals do not treat patients with these conditions or are not required to report the outcome, and therefore may not have information displayed in some categories. Children’s hospitals report three chart-abstracted measures in the preventing infections domain. These measures are specific to the population of those specialty hospitals.