Chargemaster Frequently Asked Questions
PATIENTS OR OTHERS WHO WOULD LIKE A COPY OF THE HOSPITAL’S CHARGEMASTER ARE ENCOURAGED TO READ THE FOLLOWING BACKGROUND AND EDUCATIONAL INFORMATION ON THE CHARGEMASTER.
The Mount Sinai Health System is committed to price transparency and helping patients understand their out of pocket costs. The information that can be obtained through this site lists the charges and self-pay amounts for the range of services and items provided by our hospitals.
Hospital charges are standard and depend on the complement of services rendered during your visit and stay. However, charges are not a useful tool for patients trying to determine their individual cost of care. A patient’s actual cost will vary due to negotiated rates with your insurance company and your insurance coverage which could have deductible, coinsurance, and/or copayment amounts.
Patients with insurance should contact their insurance company to best determine their potential out-of-pocket costs. A list of plans in which each hospital participates can be accessed through the hospital’s website. To obtain a list of plans, please click here and then select the applicable hospital. Patients should always confirm hospital participation directly with their health insurance plan.
Uninsured or underinsured patients should consult with our patient financial advocates to determine whether they qualify for financial assistance. Information on the hospital’s financial assistance program and other subsidized health insurance programs can be accessed here.
The following frequently asked questions have been assembled to provide additional information for patients:
What is a hospital chargemaster?
The chargemaster is a comprehensive standard list of charges for the services provided by the hospital (medical procedures, lab tests, supplies, medications, etc.). As noted above, the charges listed are generally not the amount a patient will pay.
Additionally, it should be noted that the chargemaster is not static as prices and items change during the course of the year. The chargemaster posted reflects the prices and charges in effect as of the date noted in the chargemaster file. Changes that occur after this date will be reflected in future updates.
In addition to the chargemaster, the attachment includes the hospital’s average charges by Medicare Severity Diagnosis Groups (MS-DRGs). MS-DRGs are a system of classifying inpatient cases based on a combination of medical diagnoses and human body systems.
Are charges the same for every patient?
Yes, hospital charges are standard for every service a patient receives, regardless of their insurance status. The total charges on your patient bill will reflect the actual services that you receive, which may vary based on several factors, including your length of stay, the time it takes to complete your procedure, medications and products you receive, and other health conditions that could make your care more complicated.
The hospital charges, however, do not generally reflect your actual costs. Your out-of-pocket expenses will depend on your specific insurance coverage and/or eligibility for discounted care based on the hospital’s Financial Assistance Policy as noted above.
Can a patient receive charges for services that are not included in the chargemaster?
The hospital chargemaster reflects hospital services only and does not include any professional fees such as physician services and some ancillary services that are billed separately. Please contact your insurance company for estimated professional fees and to ensure your physician is in-network eligible.
Additionally, certain costs associated with items such as blood products, implants, medications, and organ acquisition costs are subject to provider invoicing at the time of service.
Why do charges for the same procedure or item vary by hospital?
Hospitals set their standard charges for services and items based on internal metrics, including the cost to provide patient care, which varies between hospitals. For example, charges will vary based on the location of the hospital, the availability of specialized services such as trauma and transplant services, whether it is a teaching hospital, its level of underpayment from the Medicare and Medicaid programs, and services provided to the uninsured. Again, these listed charges are generally not what insurance companies or patients without insurance ultimately pay.
Why may items in the chargemaster have different prices but the same service code?
For a number of items (e.g. medical supplies, lab tests, and pharmaceuticals), the code in the chargemaster may be the same but there are different prices for each line item. This can be due to differences in dosages or other unique aspects between the items that may not be captured in the service code.
If insurance companies and patients without health insurance don’t pay the chargemaster prices, what do they pay?
Insurance companies have contracts with the hospital for discounts from charges. In addition, patients with health insurance are responsible for certain cost-sharing requirements such as deductibles, copayments, and/or coinsurance that vary by insurance plan.
Patients without health insurance can apply for support through the hospital to either receive insurance coverage (if eligible) or reduced costs through the hospital’s Financial Assistance Policy. These programs will reduce the amount owed by the patient.
How can I get an estimate of my out-of-pocket expenses for a procedure?
Patients with health insurance should contact their insurance company to get an estimate of their out-of-pocket expenses for a procedure.
Patients without health insurance can review the system’s Financial Assistance Program here. This site also contains contact information for each of the hospital’s Patient Financial Services Departments that can provide an estimate, further information about the hospital’s Financial Assistance Policy, and help determine if you may be eligible for subsidized health insurance through programs such as Medicaid.
If you have additional questions in relation to the chargemaster or the average charges by MS-DRG, please email us at email@example.com and provide your contact information. We will then have the appropriate representative respond depending upon the specifics of your question.
The Mount Sinai Hospital