2006 BISHCA COMPARISON REPORT
FAQ's Relating to Comparative Pricing and Financial Information
- What is the difference between “price” and “charge” and how are they defined?
“Price” and “charge” can be used interchangeably, and they describe what the hospital bills for the service it performs, before any discounts.
- Why is the State of Vermont reporting charges for hospital services, and what is the purpose?
Under Vermont law, 18 V.S.A. § 9405b, all Vermont community hospitals are required to report prices for “…high volume health care services.” The goal is to report “…valid, reliable, useful, and efficient information …” to be used as a tool in helping the consumer make informed decisions about their healthcare.
- Who is the audience that these reports are attempting to reach?
Consumers, the public at large, employers, and any other purchasers of health care services.
- What are the services that are included in the price lists?
There are three different price lists: inpatient charges, outpatient surgical charges, and common outpatient diagnostic charges. For inpatient stays and outpatient surgical procedures, the charges for the fifteen most common procedures performed at each hospital are shown. For outpatient diagnostic procedures, a list of some of the most common diagnostic procedures were selected from a review of websites from states and some employer claims data.
- Why do charges for certain procedures vary across hospitals?
Charges vary because of the unique circumstances related to each patient’s illness and because of the different mix of patients served and the different types and quantities of services the hospital performs.
- Is the price that’s listed for a procedure the actual amount that I will be charged and have to pay?
The prices that are listed are the average full charge for a given procedure. However, very few people actually pay full charges (see response to Question 5). The actual amount paid will depend upon many variables, including an individual’s insurance plan and the complexity of each individual’s procedure.
- What if I have insurance? How does that affect the charge and how much I will have to pay?
What you will pay depends upon your insurance plan. If you are insured, you will pay only the co-payment, co-insurance, and/or deductible required by your plan, regardless of the charge. Your insurance company in turn will pay a negotiated amount to the hospital that represents some portion of the charge -- generally less than the full price. In some cases, a negotiated discount may be able to be applied to your deductible.
- Do I have to pay the full charge if I don’t have insurance?
Some hospitals have discount policies for patients who have no insurance, under which the patient receives a discount off of the full charge similar to the discounts negotiated by insurance companies. All hospitals have free-care policies for low-income patients. You can call your hospital to learn what its policy is.
- Are physician charges included in the prices shown?
The prices shown do NOT include physician charges. The prices listed in this report are hospital prices only.
- How do I find information on charges for procedures that are not listed in this report?
If you want to find prices on procedures that are not listed, call the hospital directly and talk to their consumer services representative or someone in their billing department. In almost all cases, they can provide an estimated charge but they will not be able to give you an absolute price. Individual circumstances can affect the final charges for care.
- I keep hearing about the Chargemaster. What is it, and should I be concerned about it?
The Chargemaster is a comprehensive and hospital-specific listing of each item that can be billed to a patient, insurance company, or other payer. Every procedure has a pre-determined code attached to it and when entered into the Chargemaster, will produce a charge for that corresponding code, which is then added to the patient’s bill and becomes part of the total bill. Selected medical events for a given patient may have many codes included in the final invoice for patient care.
- Should I make a decision based on the charges listed or are there other factors I should consider?
Price is simply one factor in making a decision about healthcare. Other factors that should be considered are the location of your doctor, the services offered by a particular hospital, how many of the procedures the hospital has performed, the quality reporting by a hospital, waiting times for the procedure, etc. You also may want to ask questions of your doctor for a better understanding of possible options for your particular situation. If you have an emergency, it is recommended that you go to the nearest emergency room or call 9-1-1 if applicable.