You may be aware that the government has required hospitals post additional information on the rates they negotiate with health plans. We urge caution when looking at this data.
-There are many factors that determine the final amount that will be paid from a health plan to a provider.
-There is no way to capture all of those factors in a single set of numbers. For example:
-Rates may change depending on how sick a patient turns out to be.
-Rates may also change depending on whether patients are receiving multiple services at once, or whether the doctor learns something new about a patient's condition while providing care.
-The plan may not cover the service at all, or may impose conditions on coverage.
-We urge you to contact us to help you with estimating what you may need to pay for your care. Our Financial Customer Service counselors are here to help. Please call us at (914) 751-0372.
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Your out-of-pocket costs may depend on several factors including your insurance provider, your specific health benefits policy, expenses such as your deductible, co-insurance, co-payment and the limit of out-of-pocket expense requirements, as well as the services or procedures you receive which may or may not be covered.
We wanted to let you know that a new rule requires hospitals to maintain and make available a list of their standard charges for items and services provided. These standard charges do not reflect or represent how much you will have to pay, nor do they reflect the actual payment a hospital will receive for those items and services. You can obtain this list of charges here.
Hospitals also are required to post average charges for inpatient admissions grouped by the federal diagnoses related groups (DRGs). You can obtain this list here.
What are these standard charges and how do they impact you ? Charges are the dollar amount a provider sets for services provided before negotiating any discounts. The charge is different from the amount paid. Patients covered by Medicare, Medicaid, Commercial insurance plans, and uninsured patients who qualify for financial assistance never pay full charges. For patients who do not qualify for financial assistance, but are uninsured, we also offer steeply discounted prices.
For services provided at Saint Joseph’s, you will receive separate bills for professional charges from providers such as anesthesiologists, pathologists, oncologists or other specialists who have contributed to your care. You will also receive a separate bill for hospital charges. These charges include the cost of providing all other aspects of your care which are billed separately from professional services such as hospital stay, support staff, supplies, and medications. In addition, if your care was provided by a doctor who is affiliated with Saint Joseph’s, but also has a private practice, you may also receive separate bills from this doctor as is typical billing practice.
A list of insurance plans participating with Saint Joseph’s is provided for you here. Please note that some providers who may be involved in your care may not participate in the same insurance plans covering care at Saint Joseph’s. Therefore, we recommend you check with the physician arranging for hospital services to determine if the physician participates in a plan that covers your care. A list of physicians who provide services at Saint Joseph’s facilities is available for you here
At Saint Joseph’s we are committed to helping people understand the best options available to pay for their medical care. Our staff can help you understand what is covered by your specific health insurance benefits policy, expenses such as deductibles, co-insurance, co-payment and out-of-pocket expense limits. In addition, if you do not have insurance, we can assist you with determining your eligibility for free or low-cost insurance, as well as governmental assistance. Our Financial Customer Services counselors will assist you with the Financial Assistance Program application and with any specific questions you may have; please call (914) 751-0372.