Price Transparency

The federal government requires each hospital to post on its website a list of its standard charges for items and services provided by the hospital in a machine-readable format. Standard charges include gross charges, self-pay cash prices, payer-specific negotiated rates and min/max negotiated payer rates. The law requires hospitals to set uniform charges (the amount set before any discount) as the starting point for all bills, which is then adjusted by the negotiated insurance rates. The starting list of charges is the same for every patient, but the charges may vary by patient even though a similar procedure was performed. This may be due to the patient's medical condition, length of time spent in surgery or recovery, complications requiring unanticipated procedures, kinds of medications needed, etc.

This information allows health care consumers to receive basic, facility-specific information about their services, charges and insurance reimbursement, which is listed by payer in the columns of the file below. Anderson Hospital is committed to price transparency and has posted this list of standard charges for inpatient and outpatient services, including the chargemaster and DRG/CPT service packages. The payer rate information shows individual item/service reimbursement and does not reflect true out of pocket cost. The file below is likely not a helpful tool for a patient to know what their financial obligation will be, or to shop between hospitals. For more information about the charge for your care and to obtain an estimate over the phone, please contact our patient Financial Counselor staff at 618-391-6920.

When viewing the file, please scroll down the spreadsheet to view all Line Types, i.e. CPT, DRG’s, and move across to view all payers included in the file. Please note, a blank may not indicate the data is missing.  You may need to scroll up/down on the spreadsheet to identify the data you are searching for such as the CPT/DRG code.

The content of these files are subject to change.

Hospital Price Transparency: Patient FAQs

HOW MUCH WILL I ACTUALLY HAVE TO PAY OUT OF MY POCKET?

Patient pays:

• A patient withhealth insurance needs to pay the deductible, copay and/or coinsurance set by their health plan.
• The financial obligations could differ depending on whether the hospital or physicians are "out-of-network," meaning the health plan does not have a contract with them. Contact your insurance company to understand what your financial obligations will be.
• A patient withouthealth insurance will discuss financial assistance options available that could include either a complete write-off or a substantial reduction of the charges in accordance with the Illinois Hospital Uninsured Patient Discount Act and the hospital's financial assistance program.
• Please contact our financial counselor at 618-391-6920 to obtain further information about the discounts available.

Health insurance pays:

• Health plans such as Medicare, Medicaid, workers' compensation, commercial health insurance, etc., do not pay charges. Instead, they pay a set price that has been predetermined or negotiated in advance. The patient only pays the out-of-pocket amounts set by the health plan.
• If you need help understanding your healthcare bill, please call 1-877-444-6382.

WHAT DO THE FOLLOWING HEALTH INSURANCE TERMS MEAN?

Deductible: the amount the patient needs to pay for healthcare services before the health plan begins to pay. The deductible may not apply to all services.

Copay: a fixed amount (e.g., $20) the patient pays for a covered healthcare service, such as a physician office visit or prescription.

Coinsurance: the percentage the patient pays for a covered health service (e.g., 20% of the bill). This is based on the allowed amount for the service. You pay coinsurance plus any deductibles you owe.

A patient's specific healthcare plan coverage, including the deductible, copay and coinsurance, varies depending on what plan the patient has. Health plans also have differing networks of hospitals, physicians and other providers that the plan has contracted with. Patients need to contact their health plan for this specific information.

WHAT IS THE DIFFERENCE BETWEEN CHARGES, COST AND PRICE?

Total Charge: the amount set before any discounts. Hospitals are required by the federal government to utilize uniform charges as the starting point for all bills.

The charges are based on what type of care was provided and can differ from patient to patient for similar services, depending on any complications or different treatment provided due to the patient's health.

Cost: (for a hospital) it is the total expense incurred to provide the healthcare. Hospitals have higher costs to provide care than freestanding or retail providers, even for the same type of service. This is because a hospital is open 24 hours a day, 7 days a week and needs to have everything necessary available to cover any and all emergencies. Non-hospital healthcare providers can choose when to be available and typically would not provide services that would result in losses. A hospital's cost of services can vary depending on additional factors such as:

• Types of services it provides, since many vital services are provided at a loss, such as trauma, burn, neonatal, psychiatric and others;
• Providing medical education programs to train physicians, nurses and other healthcare professionals - again provided at a loss;
• More patients with significantly higher levels of illness, yet payment doesn't cover;
• A disproportionately high number of patients who are on public assistance or uninsured and unable to pay much, if anything, toward the cost of their care.

Total Price: the amount actually paid to a hospital. Hospitals are paid by health plans and/or patients, but the total amount paid is significantly less than the starting charges.

• On average in 2017, Medicare paid Illinois hospitals only 90% of a hospital's cost to provide that care. Medicaid paid even less.
• Medicare and Medicaid pay hospitals according to a set fee schedule depending on the service provided, much less than the hospital's total charge and actually less than their costs.
• Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges.
• Illinois hospitals provide free care to uninsured patients with incomes up to 200% of the federal poverty level (FPL) in urban areas and 125% in rural areas.
• Illinois hospitals provide discounts to 135% of the hospital's costs to patients with incomes up to 600%  FPL in urban areas and 300% FPL in rural areas.
• Illinois hospitals provided nearly $800 million in free and discounted care measured at cost in 2017.

HOW CAN I USE THIS HOSPITAL CHARGE INFORMATION TO COMPARE PRICES?

Charge information is not necessarily useful for consumers who are "comparison shopping" between hospitals because the descriptions for a particular service could vary from hospital to hospital and what is included in that description. It is difficult to try to independently compare the charges for a procedure at one facility versus another. An actual procedure is comprised of numerous components from several different departments - room and board, laboratory, other diagnostics, pharmaceuticals, therapies, etc.

Insurance rate information included in the file above is based on negotiated rates at the individual charge, CPT and DRG level and does not account for the full reimbursement methodology in the payer contracts, including multiple procedure discounts, packaged case rates, or separate rates for outlier cases.

A patient who has the specific insurance codes for services requested, available from their physician, can better gauge charge estimates across hospitals. Ask your physician to provide the technical name of the procedure that has been recommended as well as the specific ICD and CPT codes for service.

HOW CAN I GET AN ESTIMATE FOR A SPECIFIC PROCEDURE?

If you need an estimate for a specific procedure or operation, please contact the patient financial counselor office at 618-391-6920 or pull an estimate from our website here.

Such an estimate will be an average charge for the procedure without complications. A physician or physicians make the determination regarding specific care needed based on considerations using the patient's diagnosis, general health condition and many other factors. For example, one individual may require only a one-day hospital stay for a particular procedure, while another may require a two-day stay for the same procedure due to underlying medical condition.

Remember, patients with health insurance will only pay the specified deductible, copay and coinsurance amounts established by their health plan. Patients without health insurance or sufficient financial resources may be eligible for significant discounts from charges. 

Additional resources regarding healthcare prices:

Consumer Guide to Healthcare Prices816.74 KB
Consumer Guide to Healthcare Prices (Spanish)334.43 KB