Resources To Help You Better Understand Your Healthcare Costs

Avail Hospital Price Transparency

To improve price transparency, all U.S. hospitals and health systems are required to provide lists of standard hospital charges ― also called a chargemaster ― so patients can compare prices across hospitals. Here are a few considerations to keep in mind as you view the list of standard charges (chargemaster).

These charges are rarely the price that patients pay. The chargemaster lists the dollar amount set for each service prior to insurance contract/benefit plan discounts or self-pay discounts being applied, so the price patients pay tends to be less than the standard charge.

Hospital charges differ from patient to patient for the same service depending upon variations in treatment.

Patients who are eligible for financial assistance also receive additional discounts.

Items included in a charge vary across hospital systems. For example, what’s included in one hospital’s charge for room and board may differ from other hospital’s charge ― some hospitals bundle services together into a single charge that others may list separately.

Looking at various hospital charges does not provide any indication of quality of service and outcomes.

Avail Hospital Lake Charles Average Charges by Type of Patient Group.

All hospitals and health systems also are required to provide a listing of average charges by types of patient groups, referred to as MS-DRGs (Medicare Severity Diagnosis Related Groups). Patients can view similar listings posted by different hospitals, which provide a more direct comparison of charges than the standard charges in the chargemaster. View the list of average charges by type of patient group (MS-DRGs).

Avail Hospital Lake Charles Shoppable Services Prices

All hospitals and health systems also are required to post a list of at least 300 Shoppable Services along with the corresponding prices for each of those services. Each of these Shoppable Services includes the following amounts: Gross Charge, Discounted Cash Price, Payer-Specific Negotiated Charges, De-Identified Minimum Negotiated Charge, and De-Identified Maximum Negotiated Charge.

As with the list of standard hospital charges discussed above, the prices on the primary care procedures list represent the standard amount for each service prior to insurance contract/benefit plan discounts or self-pay discounts being applied. What a patient actually pays will depend on their unique benefit plan terms.

View the Shoppable Services available at Avail Hospital.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

Your rights and protections against surprise medical bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copaymentcoinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balance billed for these post-stabilization services.

Applicable State balance billing information may be found at the bottom of this notice.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

Applicable State balance billing information may be found at the bottom of this notice.

When balance billing isn’t allowed, you also have these protections:

  • You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
  • Generally, your health plan must:
    • Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, contact
Centers for Medicare & Medicare Services (CMS)
Website: https://www.cms.gov/nosurprises/consumers
Phone: 1-800-985-3059

Visit Centers for Medicare & Medicaid Services No Surprises Act for more information about your rights under federal law

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

    • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
    • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
    • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
    • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.

If you believe you’ve been wrongly billed, you may contact 337-656-7086.