Online Patient Cost Estimator Tool
At the Mount Sinai Health System, we want you to understand any bills you receive from us for health care. We want you to be able to estimate costs as you plan for upcoming procedures and services. If you have insurance, you can just provide your insurance information and select the relevant procedure code. The estimator will give you a customized cost estimate, based on the following:
- Facility fees associated with the service
- Coverage terms of your insurance plan
- Your year-to-date health care spending
This will provide your expected total facility-based out-of-pocket cost.
More Than One Bill
You may receive more than one bill for services performed at one of our hospitals depending on the nature of the visit and the services performed. The types of bills you might get include:
- Hospital bills for charges related to services, supplies, equipment, or room used during your stay (called the technical or facility bill)
- Physician bill for charges related to their professional services and/or interpretation of tests (the professional bill)
We bill separately because health insurance companies require us to bill separately for professional and technical components of your care.
This price estimator tool provides estimates for facility fees only and does not include professional or ambulance services.
If You Have Health Insurance
This tool is intended to give estimates only. If you have health insurance, you should contact your insurance company to determine all potential out-of-pocket costs. You can see a list of plans in which each of our hospitals participates on our website. To obtain a list of plans, please click here and then select the applicable hospital. You should always confirm hospital participation directly with their health insurance plan.
If You Lack Health Insurance
If you are uninsured or underinsured, you should consult with our patient financial advocates to see if you qualify for financial assistance. We explain our Financial Assistance Program and other subsidized health insurance programs on our website.
Please note that this tool can only estimate your costs for services provided at the site you select when you fill out the form. For example, this tool provides the cost of labs collected at one of our hospital locations. If your labwork is collected in your doctor’s office, it may be sent to another lab location which might be covered under a separate pricing agreement. You should always ask your provider which labs they use. Then you can check with your insurance provider to understand your out-of-pocket costs.
If you are having a complex procedure, there may be additional (ancillary) related services in addition to your primary service. The tool includes typical ancillary services in the cost estimate for more complex services. But the exact ancillary services you receive may vary from patient to patient or visit to visit. Your final bill will reflect the specific services you received. This might be somewhat different than those predicted by the estimator tool.
Frequently Asked Questions
You may have additional questions about the estimator tool. Here we address some of the most common questions.
Yes, gross charges are standard for every service you receive, regardless of whether you have insurance. The total charges on your patient bill will reflect the actual services that you receive. They will take into account several factors, including:
- Length of stay
- Time it takes to complete your procedure
- Medications and products you receive
- Other health conditions that could make your care more complicated
The gross charges do not generally reflect your actual costs. Instead, your out-of-pocket expenses will depend on your specific insurance coverage. It will also take into account whether you qualify for discounted care, based on the hospital’s financial assistance policy.
Hospitals set their gross charges for services and items based on internal metrics. This includes how much it costs them to provide the care, which may vary among 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, the bill will list the total gross charges, not what you are expected to pay.
You can check Mount Sinai’s Self-Service Patient Estimator Tool for out-of-pocket cost estimates for over 300 shoppable services. If you want to know about other services, or to verify the estimate, you can check with your insurance company (if you have insurance).
If you do not have health insurance, you can review the Mount Sinai Health System’s Financial Assistance Program. You can click on links for cost information for each hospital within the Health Care System. These links can give you:
- Contact information for each hospital’s patient financial services department (which may be able to provide a cost estimate)
- Details about the hospital’s financial assistance policy
- Help determining your eligibility for subsidized health insurance through programs such as Medicaid
If you have additional questions, please email us at firstname.lastname@example.org and provide your contact information. We will have the appropriate representative respond to you.
The tool estimates your out-of-pocket costs. These are driven by your health plan and include any fees you may need to pay. Possible fees include co-pays, deductibles, and co-insurance. These vary by insurance company and you may not have to pay each type of fee.
- A co-pay (short for copayment) is a fixed amount you pay for a covered health care service. Your insurance company may require different co-pay amounts for different services.
- A deductible is a fixed-dollar amount that you need to pay before your insurer begins to cover your medical services. You may have to pay a certain amount during your “benefits period” (often a year). After you have paid that amount, you are usually only responsible for a copayment or coinsurance for covered services.
- Co-insurance is the percentage of costs you pay for covered health care services after meeting your deductible. For example, let’s say your health insurance plan allows $100 for an office visit and your coinsurance is 15 percent. If you’ve paid your deductible, you will pay 15 percent of $100, or $15. Generally, you pay coinsurance until you meet your plan’s out-of-pocket maximum.
Our patient out-of-pocket estimator tool contains over 300 shoppable services commonly used by patients. To understand your out-of-pocket obligation for other services, please contact your insurer directly.
Every health system has its own contracts with health insurance companies. Historically, health systems have not had information about the contracts of other health systems. For this reason, each health system has negotiated its own price with each insurance company. In addition, the cost of providing care may be different from one health system to another.
There usually aren’t big changes from one year to the next. But most terms are negotiated every year, so there may be smaller changes. Your out-of-pocket costs are based on your insurance plan. Please contact your insurer or employer to understand how these costs may change year over year.
If you have any additional questions, email us and we will do our best to respond promptly.