Effective January 1, 2019, hospitals are required by law to make information available about standard charges for the items and services provided. Hospital pricing and medical billing can be complicated. While patients can find hospital charges for different kinds of medical services, most healthcare consumers never pay these rates. Actual amounts paid vary from one case to another.
Here are some frequently asked questions (FAQs) about hospital pricing:
(Much of the information below is provided by the Missouri Hospital Association.)
What factors should I consider when choosing a hospital?
Hospitals have various treatments, procedures, costs and quality ratings. All of these factors should be considered when finding a hospital that is right for you.
Why is hospital billing so complicated?
Hospital billing is based on several factors such as staffing, equipment, maintenance costs and the differences in care each patient needs. Every patient’s case is unique and requires different levels of care.
What is the difference between a charge and an expected payment?
A hospital "charge" is not the same as an "expected payment." A charge is the amount billed for a service. Because each patient’s case is different based on his or her medical condition, the patient's charge will not necessarily be the same as the average or median charge. In addition, the actual amount a patient will pay will depend on his or her insurance coverage.
How much do I have to pay if I have commercial insurance?
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. Patients should talk to their insurance company to understand all of the factors affecting their financial responsibility.
What if I need financial assistance?
Contact Phelps Health Patient Financial Services at (573) 458-7715 or (800) 634-1404 to determine if you qualify for any financial assistance or learn more here. Phelps Health offers discounts to true self-pay patients without insurance.
What if I do not have insurance?
The Phelps Health EnrollU program also can assist the public with finding affordable healthcare insurance. For more information on the Phelps Health EnrollU program, please call (573) 458-3676 or email EnrollU@phelpshealth.org.
For a list of insurance carriers that Phelps Health accepts, please click here.
For questions about standard hospital charges or cost estimates, please call (573) 458-7713.