How does a hospital determine how much to bill a patient?
Hospitals are required to bill for the individual items or services provided to a patient. A patient admitted to the hospital is charged for their room, for supplies, drugs, labs, x-rays, operating room time and other care.
If a patient has insurance, the hospital submits a bill to the insurance company for all of the services provided to the patient. The insurance company then determines the total amount owed to the hospital based upon the insurance company's contract with the hospital for that service. They then determine if the patient has to pay a portion of that amount owed, based upon that patient's insurance coverage. Usually the amount owed by the patient is not determined by the hospital's total charge.
If the patient is uninsured, the hospital bills the patient for services. Henry Ford offers discounts for uninsured patients. Contact the pricing department at 1-888-455-2678 or pricing@hfhs.org for more information. If they are unable to pay their bill all at once, payment arrangements can be made. Uninsured patients also may be eligible for financial assistance.
What is a hospital charge?
The amount a hospital bills for a patient's care is called the charge or price for that service. This is not the same as the actual cost or amount paid for the care. While each hospital's charge structure may vary, charges represent a consistent, yet imperfect, way to compare health care costs.
Generally, charges vary because no two patients are alike. Several factors influence how charges may be determined. These include and are not limited to:
Insurance discounts
Severity of illness
Labor and other costs
Range of services provided
Use of new technology
Treatment or medication ordered by physicians
How do hospitals determine prices?
Each hospital has its own policy for setting prices for on tens of thousands of different items on its price list. Most hospitals use the estimated amount it costs to provide the service or item as the major factor. In addition to that, hospitals have to factor in the sometimes hundreds of different payment arrangements they have with insurance companies. Some of these arrangements make it necessary to set a base price that is higher than the cost to provide the service in order to get paid enough to cover the costs. In many cases, uninsured patients can end up paying substantially more than insurance companies. For this reason, Henry Ford offers a discount on services provided to uninsured patients. Contact the pricing department at 1-888-455-2678 or pricing@hfhs.org for more information.
What is a physician charge?
A physician charge is a nationally recognized approximation of the cost of a physician, anesthesiologist and/or surgeon required to perform a service or procedure. Physician charges are generally billed separately from hospital charges and are paid directly to Henry Ford Health System and not to the individual provider.
Why are two separate prices, a physician price and a hospital price, listed on the price list?
Most hospitals are financially separate from their doctors, so when they provide price information, it usually does not include the doctors' charges.
Henry Ford combines the hospital and physician charges to make it easier for patients to understand their bills. Insurance companies require that we send two bills, one for the doctors' work and one for the other resources (nurses, lab technicians, supplies, drugs, etc.).
What is a facility charge?
The cost of the accumulation of services provided for a patient's care in the hospital or during outpatient surgery.
How does Henry Ford establish charges for services?
The health system reviews its charges every year and determines whether adjustments are warranted. The charges posted online are effective June 30, 2007.
What is a DRG?
DRG stands for Diagnosis Related Group. A DRG is only assigned to an inpatient hospital service. DRGs are universal groupings used by Medicare and most insurance companies to clarify the type of inpatient care a patient receives. Insurance companies use the DRG code, along with a diagnosis/CPT code and the length of the inpatient stay, to determine payment and reimbursement for claims.
What is length of stay?
The time period a patient is hospitalized from the admitting date to the discharge date.
What is a CPT code?
CPT stands for Current Procedural Technology. A CPT code is a five digit code used by all hospitals, physicians and insurance companies to identify a type of service or procedure.
What is Medicaid?
Medicaid is state program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid. For more information, visit the state Medicaid web site.
What is Medicare?
Medicare is the nation's health insurance program for people aged 65 and older. Certain people younger than 65 can qualify for Medicare also, including those with disabilities, people with permanent kidney damage, people with amyotrophic lateral sclerosis (Lou Gehrig's disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. Medicare is financed by a portion of payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security. It is administered by the Centers for Medicare Medicaid Services.
What if I have insurance? Can I tell how much I will have to pay from the price list?
No. The amount they pay is specific to their insurance plan. Because there are so many different insurance plans, we have to look up the specific insurance contract to give the patient an estimate. Our pricing department can assist patients in determining what their costs will be. Insured patients who want an estimate of out- of-pocket costs should contact our pricing department at 1-888-455-2678 or pricing@hfhs.org.
What if I don't have insurance?
We can assist patients in determining if they are eligible for Medicaid. Patients who don't quality for Medicaid may be eligible for other financial assistance.
Does Henry Ford offer a discount?
Yes. Patients who are uninsured may be eligible for a discount. Contact a pricing specialist to determine eligibility at 1-888-455-2678 or pricing@hfhs.org.
Are charges at Henry Ford Hospital different from those at Henry Ford Medical Centers?
No. The cost of services are the same.
What if a procedure is not listed on the web site?
Charges for many common, high-volume procedures are listed here. More information will be listed in the future. Contact a pricing specialist to determine the cost for procedures not listed at 1-888-455-2678 or pricing@hfhs.org.
