How Are Prices Determined?
Pricing for health care services and what you are ultimately charged depends on many factors. In addition to the basic pricing for the treatment or procedure you undergo at the hospital, your bill may include additional amounts for things such as anesthesia, medical equipment, facility use, lab tests, certain medications, radiology services, supplies, provider charges, and care involving unexpected conditions or complications based upon individual health at the time of service.
How Are Prices Calculated, and How Are Out-of-Pocket Costs Determined?
Pricing for services delivered by a hospital begins with the Charge Description Master, a price listing for all hospital items and services available to hospital personnel as they deliver patient care. All items and services used during the course of a patient’s treatment are summarized on a bill, which represents the total price of all items and services used during a patient’s treatment.
If a patient has health insurance coverage, hospital bills are first submitted to the insurance company for initial payment. The insurance company would pay for hospital services based on the negotiated contract with the hospital and the patient’s purchased insurance plan benefits. If the total balance was not satisfied by the insurance company, the hospital could seek payment from the patient, which would represent the patient’s out-of-pocket cost.
For patients who do not have health insurance coverage, Medical West has developed a cash price for services, including a balance adjustment similar to that experienced by a patient with purchased health insurance coverage. This adjustment seeks to provide some financial fairness for patients who do not have access to or the ability to afford purchased health insurance coverage.
Calculating out-of-pocket costs is often difficult, given all the factors that can impact a patient’s bill. The best way to find out is to ask. Thanks to current technology, Medical West can assist with estimating out-of-pocket costs for many of our most common services. This allows patients to better understand individual out-of-pocket costs and to satisfy that responsibility prior to receiving treatment. Medical West also recommends talking directly to your health insurance provider to better understand policy and benefit coverage and how much could be owed for a specific treatment or service.
Keep in mind that the more complex or long-term the care is, the harder it becomes to estimate costs upfront – especially if unexpected complications or other health care needs arise.
Please use the links below to access the Medical West listing of standard charges and the online patient price estimator tool:
Where Can I Get More Information about Medical West Hospital Costs?
For more information about our pricing and your specific charges, please call 205-481-8605 to speak with a financial counselor.
How Much Does a COVID-19 Test Cost at Medical West?
For patients with insurance coverage who wish to pay out of pocket for a COVID-19 test, or for those with no insurance, Medical West offers cash-based pricing. Please click on the link below to see pricing information on COVID-19 testing at UAB.
· Pricing Information on COVID-19 Testing at UAB
Resources for Consumers
- How much money do I really owe?
Every insurer, whether Medicare, Medicaid or commercial, pays the hospital differently and shares the cost with the patient differently. In fact, what kind of health coverage you have is a major factor in determining what you will pay. If you have commercial insurance, contact your insurer to confirm your coverage and your share of the costs. Your share will depend on your specific health care policy and any out of pocket costs you have already paid during the year. Also, many commercial insurance companies negotiate discounts with individual hospitals that are not reflected in billed charges.
After your insurance company has reviewed your hospital bill and paid its portion, the hospital will bill you for your part of the bill. Most insurance plans require patients to pay part of their hospital bill. If you have questions about your insurance, please contact your insurance company.
- What if I don't have insurance?
If you are uninsured and need hospital services, it is important that you contact the hospital billing office at (205) 481-7889. We can help determine if you qualify for government-sponsored assistance. Depending on your income, you may also qualify under the hospital's financial assistance policy for discounts and even free care. Payment plans may also be available to help pay for your care.
- What are Medicare and Medicaid?
Medicare is a federal health insurance program for people age 65 or older or under 65 with certain disabilities or conditions.
Medicaid is a joint federal and state program that helps with medical costs for people with low incomes.
If you have Medicare or Medicaid, the government sets the payment rates for hospitals and other providers, and those rates generally do not cover the full cost of the care provided. As with commercial insurance, there may be some out-of-pocket costs.
- How do I know if my providers are "in-network" or "out-of-network"?
If you don't know, check with your insurer. Out-of-network hospitals and other providers have not been able to negotiate a discounted price with your insurer, thus making you potentially responsible for higher personal payments. In fact, some insurers require enrollees to seek care exclusively from a specific list of hospitals and physicians under contract with the insurer for the service to be covered. Consumers who choose a provider that is "out-of-network" may even be responsible for the entire charge. Even if your hospital is in-network, you may receive care from an out-of-network physician.
If possible, always find out if all physicians who will treat you are within your health plan's network. This includes but is not limited to anesthesiologists, pathologists, radiologists or consulting doctors. If they are not within network, ask if they will accept in-network payment for services provided to you. If you're concerned that your doctor may be out-of-network, contact your insurance company.
- Who will bill my insurer for my hospital stay?
After you receive care, Medical West will bill your insurer for your care. Your insurer will send you an Explanation of Benefits (EOB) that prominently states ?This is not a bill.? Bills for any amounts you owe will be sent separately by the hospital and other providers who cared for you while you were in the hospital. EOBs provide a summary of the charges submitted to the insurer for payment, the amount that the insurer paid on your behalf and any amounts that you are responsible to pay under your policy. If the insurer has negotiated discounts with the provider, the discount will be the difference between what the hospital or other provider charged and what the insurer paid plus the amount you owe the provider.