HOSPITAL PRICING INFO

BILLING

We know that health care billing can be confusing. Divine Savior Healthcare is committed to helping our patients understand the cost of their care. For information that would help you estimate the cost of your care or the amount you might owe for your care, please contact our Concierge at (608) 745-6239 or concierge@dshealthcare.com . You can find information about our Financial Assistance Policies here (https://dshealthcare.com/Financial_Services). To help our patients better understand healthcare services, the cost of their care, and comparison shop between Wisconsin hospitals, additional information is available at www.wipricepoint.org .

The Centers for Medicare and Medicaid Services (CMS) as part of the 2019 IPPS Final Rule requires hospitals to make available online a listing of standard hospital charges for each inpatient and outpatient service and item provided. Divine Savior Healthcare supports the intent of these regulations to educate patients on the cost of health care and the patient financial responsibilities. Our chargemaster list is available in a machine-readable format here.

 

BILLING FAQs

WHAT IS A CHARGEMASTER?

A chargemaster is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital – each test, exam, surgical procedure, room charge, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a chargemaster contains thousands of services and related charges.

The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted rates to the services that are billed. In situations where a patient does not have insurance, a hospital has financial assistance policies that apply appropriate discounts to the amounts charged. More information on the hospital’s financial assistance policies can be found at https://dshealthcare.com/Financial_Services.

Health insurance companies contract with hospitals to care for their customers. Hospitals are paid the insurance company’s contract rate, which can be significantly less than the amount listed on the chargemaster. The insurance company’s contract rate, not the chargemaster, can be the basis for determining the patient’s actual out of pocket costs. As an example, a hospital may charge $1,000 for a particular service, while the insurer’s contract rate may be $700. If the patient’s insurance plan indicates the patient is responsible for 20 percent of the contract rate, the patient would owe $140 ($700 x 20 percent).

 

ARE CHARGES THE SAME FOR EVERY PATIENT?

The list of charges is the same for all patients. However, the total charges for an individual patient often vary from one patient to another for a number of reasons, including:

  • How long it takes to perform the service or how long it takes the patient to recover in the hospital
  • Whether the service or procedure the patient receives is more or less difficult than expected
  • What kinds of medication the patient requires
  • Whether the patient experiences complications and needs additional treatment
  • Other health conditions the patient may have that may affect the patient’s care

 

IS THE CHARGE THE SAME AS WHAT A PATIENT PAYS?

Chargemaster information is not particularly helpful for patients to estimate what health care services are going to cost them out of their own pocket.

If a patient has health insurance, the amount the patient will be billed and expected to pay for the patient’s services depends on the patient’s specific health insurance coverage and the patient’s insurance company’s contract with the hospital.

If the patient does not have health insurance, the patient may be eligible for reduced costs under the hospital’s financial assistance policy, or the patient may be eligible for Medicaid coverage.

 

WHAT IS NOT INCLUDED IN THE CHARGEMASTER LIST?

The hospital’s chargemaster does not include charges for services provided by the doctor (or doctors) who treat the patient while the patient is at the hospital. The patient may receive separate bills from the hospital and the doctors involved in providing the care.

Here is a partial list of health care providers who may bill the patient separately:

  • The patient’s personal doctor, if he/she sees the patient in the hospital
  • The surgeon who performs the patient’s procedure
  • The anesthesiologist who works with the surgeon
  • The radiologist who reads x-rays or other imaging
  • Other doctors who may be consulted by the patient’s doctor during the patient’s time in the hospital
  • Laboratory services
  • Pathology services
      

ARE CHARGES DIFFERENT FROM PAYMENTS?

Yes, charges are different from payments. Chargemaster information is not particularly helpful for patients to estimate what health care services are going to cost them out of their own pocket.

  • The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted rates to the services that are billed. In situations where a patient does not have insurance, our hospital has financial assistance policies that apply discounts to the amounts charged. More information on our financial assistance policies can be found at https://dshealthcare.com/Financial_Services.
  • Each hospital has different proportions of Medicare, Medicaid, commercial insurance or uninsured patients, which adds to the complicated nature of hospital billing.
  • Every insurer pays the hospital differently. Medicare and Medicaid generally pay less than the actual cost of caring for patients.
  • There are also patients who, unfortunately, can’t pay their hospital bills. As Wisconsin’s health care safety net, hospitals treat uninsured and underinsured patients every day.

 

HOW IS INFORMATION SHARED WITH PATIENTS AND FAMILIES?

The chargemaster is not a useful tool for consumers who are comparison shopping between hospitals.

  • Our hospital employs financial counselors and other resources to help our patients understand their financial obligations. Please contact our Concierge at (608) 745-6239 or concierge@dshealthcare.com.
  • We encourage patients to reach out and ask detailed financial questions – especially before scheduled services.
  • Our hospital is ready to help patients and their families understand their financial obligations at any time during the treatment process.

 

WHAT IS PRICEPOINT? www.wipricepoint.org

The PricePoint website provides health care consumers with facility-specific information about healthcare services and charges. Consumers can query information for inpatient services, outpatient surgeries, emergency department and urgent care visits, observation services, and ancillary services, such as radiology and therapy services.

  • PricePoint was designed for consumers. It includes with many helpful consumer resources.
  • Charge information is updated quarterly using the most current four quarters of data available.
  • Consumers can easily compare charge information for multiple hospitals.
  • PricePoint also uses data provided by the Wisconsin Health Information Organization (WHIO) to provide health care consumers with information related to professional, rehabilitation, skilled nursing, ancillary, and pharmacy services that are not part of the hospital facility charges included with the WHAIC data.