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 (The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai Beth Israel, Mount Sinai Brooklyn, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai St. Luke’s, and the New York Eye and Ear Infirmary of Mount Sinai) is committed to being transparent about its charges. The information that can be obtained through this site lists the charges for the range of services and items provided by a hospital, which is also known as the hospital’s chargemaster. These charges are uniform for each respective service provided by the hospital. However, the hospital charges rarely reflect the expected out-of-pocket expenses for a specific hospital patient stay or encounter. A patient’s actual costs, i.e. one’s out-of-pocket expenses will depend on one or more of the following:
- Charges billed are based on the specific services a patient may receive during their stay at the hospital so there are variations from case to case.
- Charges are different from the actual costs/expenses that each patient is responsible for paying; the portion of charges that a patient may eventually pay is based on their insurance coverage which could have deductible, coinsurance and/or copayment amounts.
- Uninsured patients residing in New York State are eligible for financial assistance from Mount Sinai.
Patients with insurance should contact their insurance company to determine what their potential out-of-pocket costs will be for a hospital stay in the near future or were recently in the hospital. Your insurance plan will be able to provide the amounts you may owe for deductibles, coinsurance or copayments based on the specifics of your coverage. 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.
Patients without insurance may be eligible for subsidized health insurance through programs such as Medicaid or the hospital’s Financial Assistance. Uninsured patients generally will not pay more than the rates paid by the Medicare Program and will often pay much less than this if they qualify for subsidized health insurance or charity care. Information on the hospital’s Financial Assistance program and other subsidized health insurance programs can be accessed here.
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.
- Hospital charges will change from time to time as many are based on the cost of a medical supply or drug. As costs change, chargemaster prices are updated.
- New items (services, medical supplies, drugs, etc.) will be added to the chargemaster as necessary and items no longer in use may be deleted.
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. All of this information can be obtained along with the chargemaster detail by following the steps at the end of this informational page.
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 price list for the services provided by the hospital (medical procedures, lab tests, supplies, medications, etc.). Because it represents the full range of services the hospital provides, there are thousands of items listed. As noted above, the charges listed are generally not the amount a patient will pay.
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 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 that are billed separately. For estimated professional fees, please contact your physician’s office. You should also ask the physician arranging for your hospital services to determine whether the services of any other physicians will be required for your care. Your physician can provide you with the name, practice name, mailing address and telephone number of any physicians whose services may be needed. Your physician will also be able to tell you whether the services of any physicians employed or contracted by the member Hospital are likely to be needed, such as anesthesiologists, radiologists and pathologists. The contact information for these physicians is available through the Find a Doctor link at the top of the hospital’s web page.
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 description?
For a number of items (medical supplies, lab tests and pharmaceuticals), the description in the chargemaster may be the same but there are different prices for each line item. This can be due to differences in sizes, dosages or other unique aspects between the items that may not be captured in the description.
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 firstname.lastname@example.org and provide your contact information. We will then have the appropriate representative respond depending upon the specifics of your question.
I have read the above information and understand that charges may not be representative of the amount I may be billed.
New York Eye & Ear Infirmary of Mount Sinai