What is pricing transparency?
“Pricing transparency” is the term used to describe initiatives in the healthcare industry to provide meaningful pricing information to consumers. The healthcare industry is often complex and difficult for consumers to navigate. Price transparency is a means of providing consumers price information on common services. Our hospital is committed to presenting pricing information on its website in a way that will be easy for the consumer to access and understand, as well as providing other useful information about financial assistance available, definitions of key terminology, and key financial policies.
What services are included in my hospital bill estimate?
If you are viewing estimates provided on this website, the pricing includes estimated room and board (for inpatients), supplies, nursing care, equipment use implanted devices, nutritional services, and any services handled by the staff of the hospital within the walls of the hospital. It does not include services listed below.
What services are excluded from my hospital bill estimate?
Your personal physician or other physicians providing you with services related to your hospital stay or visit will bill you separately. This can include fees related to specialists, anesthesiologists, pathologists, and radiologists. Independent pathologists (laboratory) and radiologists (imaging) services will also bill you separately for reading and interpreting EKG’s, X-rays, EEG’s and lab work.
How were “top services” determined?
We pulled data from the most recent calendar year to determine our most common inpatient admissions. Inpatient services include a hospital stay of at least 24 hours while patients admitted and discharged the same day are considered outpatients.
How often is the pricing estimate data refreshed?
We plan to refresh the data used on our website and by our Service Representatives annually.
What does “Uninsured” mean?
It means that you have to pay for your services and that you do not have coverage for the hospital services by a third party like Medicare, Medicaid, Workers Compensation or an insurance company. Other common terms used when referring to Uninsured patients are: Self Pay and Private Pay.
Why can’t I rely on the pricing estimates posted on this website if I have insurance?
Those figures are estimates of what the hospital would be paid by a range of insurance companies and self insured individuals. The specific payment for your care could be anywhere in this range or outside of it. If you have insurance or some form of medical coverage, your out of pocket typically can include a deductible, coinsurance, co-payment or even non-covered services. The prices for your services are based on the contract terms negotiated by your insurance company with the hospital. In order to give you a more accurate estimate, we need to evaluate your coverage and specific plan. To do that, please give us a call at 1-800-464-1722.
What if the service I need is not listed on this website?
Please give us a call at. We will be happy to try to provide you with a price estimate.
When I call for a pricing estimate, what information do I need to have available?
Before you call, it is a good idea to contact your physician’s office to get the best description possible of the services that you need. Then, if you have insurance, contact your insurance company and make sure that the services required are “covered services” under your specific plan. If they are not “covered”, then you would be considered “uninsured” for these services.
When you call us, please try to have the following information at hand so that we can provide you with our best estimate of your financial responsibility:
- Description of services needed – we will need to know as much information as possible about the specific services needed as described by your physician.
- Type of services needed – we need to know if you will be admitted to the hospital as an inpatient overnight, or if you are expected to be treated on an outpatient basis.
- Physician/Specialist Name – example, if you are having surgery, we will want to know the surgeon’s name.
If you have insurance, we will also need:
- Your insurance card – please have your card available so that, if needed, we can get the following information from you: name of insurance company, type of policy (e.g. HMO, PPO, POS, Indemnity), policy holder’s name, group name and number, policy number, insurance company phone number.
- Policy holder’s personal information – it is possible that the insurance company will want us to verify the Social Security Number and date of birth of the person who is named as the primary insurance policy holder.
Can I get an exact pricing quote?
Unfortunately, no. We will do our best to provide you with a pricing range based on our hospital’s historical pricing for comparable services. Price quotes are not guaranteed since the services used to compute the quote can vary from services you receive due to treatment decisions, unforeseen complications, additional tests or services ordered by your physician, and variation in the clinical needs of each patient.
What is expected of patients in terms of payment?
Similar to your visits to your physician’s office, we expect payment at time of service. If you have insurance or other coverage, we will expect you to pay your copayment, coinsurance and/or deductible upon arrival at the hospital. After your insurance company pays us, we will send you information about any amount you may still owe.
If you are uninsured, we expect payment at time of service (or will work with you to arrange monthly payments) for the estimated price of your services. If, after your services are received, any additional payment is due, we will send you information about any amount you may still owe. If you receive emergency care and cannot pay for your services, with your cooperation, our financial counselors will evaluate whether you qualify for Local and State programs, including county assistance and Medicaid / Medi-Cal, or our Financial Assistance Discount Policy.
We accept major credit cards, checks, money orders and cash.
Do you have a Financial Assistance policy?
We provide free hospital care for patients who are lower income and do not meet qualifications for Medicaid. In order to qualify for this free care, you must complete a Financial Assistance Application and provide some documents to support your income. Our full Financial Assistance policy may be reviewed by clicking here.
For patients who do not meet the charity criteria and will be expected to pay for services out of pocket, we offer a self-pay policy with a discount similar to that received by managed care health plans. All uninsured patients (excluding those receiving cosmetic procedures and certain “package” procedures) will be given an uninsured discount.
How does the insurance billing process work?
If you are insured, a claim will be sent to your insurance company. After they receive the claim, the insurance company may contact you for additional information. Please respond to your insurance company’s questions as quickly as possible so payment is not delayed. It usually takes 30-45 days for your insurance company to pay your claim. After they pay us, we will provide you with information about any amount you may owe that you did not already pay upon arrival at our facility. Please keep in mind that your policy is an agreement between you and your insurance company. If you did not follow your insurance plan’s terms, they may not pay for all or part of your care.