Transparency

Price Transparency/Price Estimator

Washington Regional Medical Center makes public a list of its standard charges and standard charges per DRG (diagnosis related group) in a machine readable format. This information is updated at least annually.  

Charges 

A hospital has a price list similar to most businesses. In a hospital, this list is called a “Chargemaster” or Charge Description Master (CDM). A Chargemaster is a comprehensive list of all the billable items and services provided within the hospital. For example, it includes various medical procedures, lab tests, supplies, and medications. A hospital charges for every item used in the care of a patient. The billed charges for every item are the same for every patient. The unique complexity of each patient’s condition generally results in usage of different charge items. As a result, very few patients have identical charges. Please note that billed charges only cover the hospital’s charges; they do not cover professional fees of physicians and other professionals who may provide care to you within the hospital. For example, if you are seen in the Emergency Department by a physician you will receive a separate bill for his/her service. If you need surgery you will also receive a separate bill from the surgeon, the anesthesiologist, and maybe even a radiologist, pathologist or physician who interpreted a cardiology exam like an EKG.

DRG

DRG, or diagnostic related grouping, is how Medicare and some health insurance companies categorize hospitalization costs and determine how much to pay for a patient's hospital stay. Rather than paying the hospital for what it charges while caring for a hospitalized patient, Medicare pays the hospital a fixed amount based on the patient’s DRG or diagnosis.

Allowed Amounts

Just because a hospital bills for each item or service doesn’t mean it collects the full amount of charges. In fact, hospital collections rarely equal the amount of charges. In most situations, the amount a hospital actually receives is less than the price stated on the Chargemaster. In the vast majority of cases, the hospital collects the amount determined by a third-party payor, e.g. Medicare, Medicaid, or commercial insurers. Payors contract with hospitals to provide services to their insured members or beneficiaries. These contracts employ various and often complex methodologies to establish “allowed amounts”. Once an allowed amount is determined by a payor, the payor also determines what portion, if any, the hospital must collect from the patient and what portion, if any, will be paid by the payor. The patient responsibility is known as “out of pocket” cost and can consist of any and all of the following: deductible, co-insurance, or co-pay.      

Uninsured patients

A small percentage of patients are uninsured and therefore have no third-party payor to establish an allowed amount or make payments on their behalf. All uninsured patients at WRMC receive a 25% discount from billed charges. Many uninsured patients qualify for financial assistance and are eligible to receive free or highly discounted services. 

Financial Assistance

We provide financial assistance for patients that have received non-elective care, who do not meet qualifications for Medicaid, and whose income is less than 200% of the Federal Poverty Level. In order to qualify, you must complete a Financial Assistance Application and provide appropriate documentation of your income. Financial Assistance is also available for patient balances after insurance for qualifying individuals. Patients who do not meet the criteria for assistance will be expected to pay for services.   

Click here to view the Financial Assistance web page.

Charges vs. Out of Pocket Cost (OOP)

The best way for a patient to determine their OOP cost for a procedure is to contact their insurance company (payor). WRMC, upon request, attempts to calculate an estimate of the patient’s OOP and has been doing so since 2006. However, WRMC’s estimate is exactly that – an estimate. It is not possible for WRMC to know in advance of care what particular items or services may be utilized in a particular patient procedure nor is it possible for WRMC to know all of the particular terms and conditions of a third-party insurance contract. It is a good idea to contact your physician’s office to get the best description possible of the items and services that you need. Then, if you have insurance, contact your insurance company and make sure that the items and services are “covered services” under your specific plan. If the items or services are not “covered” then you would be considered “uninsured” with respect to those items or services.

When you call us, please try to have the following information at hand so we can provide you with our best estimate of your financial responsibility. Please call 479-463-2600 to request an estimate:

• 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.
    

What is expected of patients in terms of payment?

Similar to your visits to your physician’s office, payment is due at the time of service. If you have insurance or other coverage, we expect you to pay your co-payment, coinsurance and/or deductible upon arrival at the hospital. After your insurance company pays us, we will send you a statement about any additional amounts you may still owe. Outstanding balances should be resolved within three months. Washington Regional has short term (3 months) payment plans and longer term interest free loan programs to assist you in paying your outstanding balance.  

If you are uninsured, we expect payment at the 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 State health care programs, such as Medicaid, or qualify for our Financial Assistance program.