In 2018, The Center for Medicare and Medicaid Services (CMS) finalized the 2019 Inpatient and Long-Term Care Hospital Prospective Payment System (IPPS / LTACH PPS) rule, which now requires hospitals to publicize a listing of their standard charges online. CMS has stated that their intent behind this ruling is to empower patients by providing them information on healthcare pricing.
While pricing information can be useful, patients should consider many factors when making healthcare decisions. Other factors to consider include facility quality, safety, patient outcomes, and overall value. Saint Francis strives to provide the best overall value (combination of quality and pricing) to the region we are privileged and honored to serve.
Do Saint Francis’ total charges represent my personal out of pocket costs?
Most government payers provide what is known as “fixed payments,” meaning that regardless of what Saint Francis “charges” for a service, the cost to the payer and the cost to the patient are not impacted by the total charge. It is always best to obtain a personal out of pocket estimate from our patient financial services department. You may also estimate your cost for services using our automated tool.
Example: As of November 2018 Medicare pays Saint Francis Medical Center $55.77 for a 2-view chest x-ray. This means that no matter what Saint Francis “charges” for this x-ray, Medicare only pays or contractually allows this fixed payment. Anything charged above $55.77 is adjusted off to what is called a “contractual adjustment.” The difference is not billed to the patient or insurance company. We will explain contractual adjustments more in detail below.
What is a “contractual adjustment?”
A contractual adjustment is a discount amount provided to patients that carry insurance coverage with which Saint Francis has a contract or agreement. These discounts are provided to encourage patients to seek care at “in-network” facilities and physicians.
Who pays the contractual adjustment amount?
Neither patients nor the insurance company pays for the contractual adjustment amount. This is a discount Saint Francis provides to the insurance companies which then gets passed along to patients.
Who can I contact if I have questions or would like additional information?
The Saint Francis Customer Service Department can be reached by calling 573-331-5217, option #4.
Who can I speak to if I am having difficulty paying for my bills received by Saint Francis or if I would like a personal cost estimate?
The Saint Francis Financial Counselors can be reached by calling 573-331-5217, option #2.