Cleveland Area Hospital Price Transparency
INTRODUCTION
At Cleveland Area Hospital and Lake Area Medical Associates, we continually strive to provide superior healthcare and transparency for the members of our community. Understanding the details of healthcare billing and insurance can feel stressful due to issues like confusing terminology, complex insurance information, and an overall lack of transparency within the healthcare industry. In compliance with the Centers for Medicare and Medicaid Services (CMS), Cleveland Area Hospital is expanding transparency by providing the public with a directory of our standard charges, known as a “Charge Master” (or “CDM”) and a “Shoppable Services” directory.
The Charge Master and Shoppable Services files are directories of healthcare services provided by the hospital and clinic, including the standard charge for each service. Before searching through the Charge Master or Shoppable Services files, it is important to note that the hospital or clinic’s standard charge is NOT the same as what you or your insurance company typically pays for a service. The standard charge is a combination of the full operating expenses involved in providing healthcare, both direct expenses (direct nursing care, meals, supplies, etc.) and indirect expenses (i.e. a fraction of total operating costs like new equipment, non-clinical staff, building & utility expenses, etc.). However, like most businesses, almost no one pays the standard charge. Instead, insurance companies or self-pay patients pay a negotiated discount. Standard charges are simply a tool that hospitals or health providers use to negotiate discounts in contracts with insurance companies and to evaluate the financial impact of those discounts on the financial health of their institution. Standard charges are the same for all patients, but a patient’s financial portion of a hospital or clinic bill will primarily depend on the financial payment negotiated by insurance companies with the hospital or clinic.
The Cleveland Business Office is dedicated to assisting patients with any questions or issues regarding their billing or insurance. In addition, uninsured patients should contact the Business Office to discuss self-pay discounts. Please contact the Cleveland Area Business Office at 918-358-2501.
CHARGE MASTER(CDM) STANDARD CHARGES FILE:
The Charge Master is a machine-readable file listing all Cleveland Area Hospital and Lake Area Medical Associates’ services. CMS developed a list of elements it requires hospitals to list in a publicly available file identifying the hospital’s standard charges and other transparency information on their website. The Charge Master file contains a specific healthcare industry code, service description, and standard billed charge for each service the hospital or clinic renders. Added to the usual Charge Master items listed above, the Charge Master file includes the minimum reimbursement, maximum reimbursement, and payer-negotiated reimbursements (i.e. insurance company reimbursement) for each specific code.
Please contact the Cleveland Area Hospital Business Office, 918-358-2501, for any questions about the Charge Master file listed below.
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SHOPPABLE SERVICES FILE:
Shoppable Services is a machine-readable file listing 300 common Shoppable Services provided by the hospital, including some services required by CMS. As identified in the Charge Master file, the Shoppable Services file includes each standard charge, minimum reimbursement, maximum reimbursement, insurer-specific reimbursement, along with consumer-friendly service descriptions.
Please contact the Cleveland Area Hospital Business Office, 918-358-2501, for any questions regarding the Shoppable Services file.
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NOTE:
The best way to determine your personal out-of-pocket costs is to contact your insurance company (contact information is typically on the back side of your insurance card). Your insurance company can provide the most current and accurate information, including covered benefits, deductibles, co-insurance and/or co-pay amounts for your particular health plan and provide you with the best cost estimate for a specific service.
Standard charges are billed to insurance companies or government plans, like Medicare or Medicaid. They rarely reflect your actual out-of-pocket costs. Your out-of-pocket costs will be a portion of the insurance health plan’s “allowed amount” (which is the negotiated rate your insurance company agreed to reimburse the hospital or clinic for a service). Your insurance health plan’s Summary of Benefits can identify the total deductible, coinsurance, or copay amounts for a type of service. However, your insurance company is the best source of information to determine your current out-of-pocket costs for a specific service (any applicable deductible, coinsurance, or copay amounts owed).
The Cleveland Area Hospital or Lake Area Medical Clinic can, upon request, provide an estimated total of your out-of-pocket costs at the time of scheduling or registration. However, your insurer can provide the most up-to-date patient liability amount for healthcare services. Please be prepared to provide patient, contact, and insurance information in addition to individual tests or procedures for the estimate.