Patient Pricing Transparency
Patient Pricing Transparency
Centers for Medicare and Medicaid Services (CMS) has taken on the initiative to improve healthcare price transparency. This initiative aims to empower patients by promoting healthcare price transparency in an effort to reduce the burden on both the patient and the provider. Through guidelines, the federal agency requires hospitals to make a list of their standard charges public and posted online. In compliance with the CMS requirements, Mena Regional Health System is making public a copy of our Charge Master, which lists our hospital standard charges for all services, drugs, and supplies. We have also provided the Average Inpatient Charge for the most commonly used DRGs (Diagnosis Related Group) at our facility.
Before you search through this file to learn what it may cost you to receive an item or service provided at MRHS, it is important to understand that what the hospital charges for service is NOT the same as what you or your insurance company pays for a service. In fact, virtually no one pays the charges you will see listed.
Charges are simply a tool that healthcare providers use to negotiate contracts with insurance companies and to evaluate the financial impact of those negotiations on the financial health of the institution. Charges are the same for all patients, but a patient’s responsibility may vary depending on payment plans negotiated with individual insurers.
What Does the Hospital Actually Get Paid?
Mena Regional Health System seldom – if ever – is paid the full amount of billed charges. The hospital negotiates payment rates with every major insurance company that provides coverage to residents in our community. As part of that negotiation, the insurance company typically establishes an “allowable” rate for each item or service and then establishes a discount from that “allowable” rate that they pay, minus any deductibles, coinsurance, and co-pays that the insurance company deems the patient’s responsibility. This “allowable” rate typically falls well below hospital charges.
If the insurance company refuses to contract with the hospital, or if the hospital is unable to negotiate a satisfactory contract with the insurance company, MRHS may be considered out-of-network with that plan. The insurance company may then chose not to pay for the services you receive at an out-of-network facility, increasing your out-of-pocket expenses.
It is likely that your insurance company has negotiated different payment rates with each hospital under contract.
What about Charges on Deductibles, Coinsurance, and Copayments?
Deductibles vary by insurance company and reflect the plan you or your employer selected and the premium paid for that coverage. Lower deductible plans typically have a higher monthly premium, while higher deductible plans have a lower premium. The deductible is the amount you will pay each year before you receive benefits from your insurance company.
Established by your insurance company and plan, coinsurance is a percentage of the “allowable charge” you will pay after you have reached your deductible. Also established by your insurance company or pay, co-pays are a flat fee you pay for a health care service. Co-pays can take effect either before or after your deductible has been met and may not apply to all services.
Information about your deductibles, coinsurance, and copayments is available from your insurance company or employer.
What about Medicaid?
Medicaid pays all hospitals based on the same fee schedule. You can view fee schedules by visiting the Arkansas Medicaid website.
What about Medicare?
Medicare payments are based on a predetermined, fixed amount. The payment amount for a particular service is based on the classification system of that service. If you have a supplemental plan, it will cover some or all of your deductible, coinsurance, and co-pays. You will need a separate Medicare Part D plan to secure insurance coverage for drugs.
If you have enrolled in a “Medicare Advantage Plan,” you no longer have traditional Medicare. These “plans” are offered by private insurance companies and have different monthly premiums, deductibles, coinsurance, and co-pays. Some of these plans also include drug coverage.
Information about your deductibles, coinsurance, and co-pays is available from the insurance company that sold you the “Medicare Advantage Plan.”
What about Uninsured Patients?
Uninsured or underinsured patients should consult with our business office to determine their financial liability.
At Mena Regional Health System, our goal is to provide our patients with high-quality care and the best customer service experience, from registration to discharge. We know that understanding service charges, insurance, and billing can be overwhelming, and our goal is to help you understand your options. If you have any questions concerning our services or pricing or to obtain a personalized estimate of your intended service, contact us at 479-243-2333, Monday-Friday, 8:00 am to 4:30 pm.
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For any additional questions about billing, please call 479-243-2333.