The Centers for Medicare and Medicaid Services (CMS) mandated hospital price transparency that went into effect January 1, 2019, whereby, Hospitals are required to make available a list of their current standard charges via the internet in a machine readable format and update this information at least annually, or more often as appropriate.
This format is a commonly utilized format that CMS utilizes for quality data submissions, and many other aspects of data sharing outlined in other CMS policy. However, provider organizations and patient advocates both agree that the realities of medical-industry pricing still make it difficult for consumers to comprehend this data. No patient ever pays the pricelist price. Insurance companies negotiate a specific discount for their customers. In addition, uninsured individuals have access to a variety of state and federal government programs and additional discounts that can be reviewed with a financial counselor prior to service.
Therefore, this file is not the best representation of the amount a patient or consumer will pay, because the final bill a patient receives is always discounted. Insurance companies negotiate discounts on the pricelist amounts by as much as 40% or more. In addition, patients’ have varying degrees of financial responsibility relative to how valuable their insurance coverage is. This means that patients will have higher or lower copays, co-insurances, and deductibles. The patient must pay an amount up to their deductible before the insurance begins paying benefits. These deductibles can be as low as five hundred dollars or as high as ten thousand dollars depending on how much coverage that individual purchased or their employer is providing on their behalf. In addition, after the deductible is paid by the patient, the patient will often owe 10-20% of the insurance’s negotiated amount up to a maximum individual or family amount. The patient’s coverage level as well as their insurance carrier’s negotiated amount may vary greatly, and therefore, the price each consumer pays is very personal.
For these reasons, AdventHealth aspires to give consumers meaningful information as they seek to restore their health. We believe consumers should be equipped with personalized and accurate estimates. We are making it easier for patients to make informed decisions about their health care by offering them personalized estimates for hospital procedures before their care. The estimates are based on their insurance coverage and the typical care experience for patients receiving similar services from the same physician. These personalized estimates are accessible in the “My Billing” section of this website.