As required by the Centers for Medicare & Medicaid Services’ (CMS) all hospitals must make available a list of their current standard charge amounts for medical services via the Internet in a machine-readable and searchable format, and to update this information at least annually. Below is some important information to help you understand the information provided by Good Shepherd Penn Partners (“Good Shepherd”).
How To Understand our Charges
A chargemaster is a list of medical codes and prices for everything a hospital provides to patients.
- Each hospital has its own chargemaster list that is used for billing purposes
- Charge amounts that appear on all patient bills are the same dollar amounts billed for the same like services to all patients and all insurances. However, actual billed amounts for a patient’s visit may vary due to the combination of services provided during that particular visit.
- Hospitals participate with a number of insurance companies that include Medicare, Medicaid, Blue Cross and many other commercial payers. The chargemaster list is not the negotiated price between hospitals and insurance companies, and it is not the price that most patients would pay for care.
- The chargemaster list is not the best tool for patients to figure out the cost of their health-care services, because most people do not know all the medical codes that would be used for their care before they receive treatment.
- The prices on the chargemaster list are not the actual payment rates that hospitals receive. And chargemaster prices are almost never the actual amount a patient is responsible for.
How Much Will I Pay?
The best way to understand what you will pay out-of-pocket is to work with your hospital and your insurer.
- Charge amounts are typically set during the budgetary process and are much higher than what an insurance payer and patient are expected to pay.
- Individuals with insurance are typically responsible to pay any copayments, coinsurance, or deductible amounts as outlined in their insurance policies. These out of pocket costs are determined by governmental and commercial payers and are defined as follows:
- Copayments – The fixed amount of out-of-pocket costs a patient will pay when visiting a health-care provider for a particular service.
- Co-Insurance – The percentage amount of covered benefits that the patient is responsible for paying after reaching their deductible if appropriate.
- Deductible – The amount you owe for health-care services before your health insurance plan begins to pay.
- Individuals without insurance may be eligible for financial assistance or charity care, or may be able to receive a reduced price from the hospital. Click here for more information regarding charity care at our hospital.
- You may receive care from several different providers during your hospital stay or outpatient services. For example, you may see a physician not employed by Good Shepherd, have an X-ray taken and read by another provider, get blood work done, receive anesthesia for a procedure, require special medications or need medical transportation. Several of the individuals and organizations that provide these services are independent of Good Shepherd. These health care providers have their own charges and billing processes. These provider may include but are not limited to:
- Radiology services
- Dialysis services or other dialysis providers
- Physicians and other providers not employed by Good Shepherd
- Other hospitals
- Pharmacy/other pharmacies
- Medical transportation
As mentioned above, the hospital charge amounts published are not the amounts expected to pay by patients and insurances. For an estimate of what a patient’s out of pocket costs will be, please contact the Good Shepherd Patient Financial Services Department at (610) 776-3282 or (877) 807-2840.
If you have questions regarding your out-of-pocket cost for a specific service related to Penn Medicine Rehabilitation, contact our Financial Estimators at [email protected]