Michigan hospitals are committed to increased transparency around healthcare costs, including price information for consumers.
- Michigan hospitals share cost information with patients every day. The best way for any patient to get meaningful price information is to contact the hospital with their specific treatment needs. Every patient, and every patient’s needs and complications, is different and requires individual attention.
- The federal government requires hospitals to post on their website a list of standard charges for each inpatient and outpatient service and item they provide.
- Healthcare billing, costs and charges are very complex. Much of hospitals’ costs are for employees’ wages and benefits. The price a patient sees on a hospital bill reflects the people who care for them and otherwise work in the hospital, not just the services, goods or medications provided. Hospitals recognize that more needs to be done to simplify the billing process for patients.
- Because of widespread variation in health insurance coverage, it is difficult for hospitals to provide patient-specific out-of-pocket cost information without access to very detailed information about a patient’s health insurance coverage.
- Healthcare experts throughout the US have cautioned that the charge information is not helpful to understanding individual patient expenses, and can instead lead to further confusion.
How is patient out-of-pocket cost information shared with patients and families?
- The pricing transparency file is not a useful tool for consumers who are comparison shopping between hospitals.
- A hospital employs financial counselors, patient advocates and other resources to help our patients understand their unique financial obligations. We encourage patients to reach out and ask detailed financial questions (especially before scheduled services). The hospital’s financial counselors can review options for charity care, payment plans, discounts and more.
- People should not try to determine specific out-of-pocket costs for a particular service based on the pricing transparency file. If a person has health insurance, they should first turn to their own insurance company for co-pay, coinsurance and deductible information. If uninsured, they should contact the hospital’s financial counselors to discuss their personal treatment needs and get an estimated cost of care. In situations where a patient does not have insurance, patients may be eligible for free or reduced-cost healthcare services through various state public assistance programs like the Healthy Michigan plan, as well as the hospital financial assistance programs. Most hospitals have staff who specialize in helping a patient apply for and enroll in Medicaid programs and the Healthy Michigan Plan. In situations where a patient does not have and is not eligible for any insurance, the hospital has financial assistance policies that apply discounts to the amounts charged. More information on our financial assistance policies can be found on the Billing / Financial Assistance Page.
- Patients are encouraged to use out-of-pocket cost, quality and patient safety information together to make an informed healthcare purchasing decision. Hospital-specific quality and patient safety information is publicly available at www.verifymicare.org.
Hospital costs for patients vary for a number of reasons.
- Every patient’s case is unique and requires varying levels of care and specific caregivers making no two patient experiences, even for the same services, the same.
- The price a patient sees on their hospital bill reflects not just the specific care team who treated them, but also overall operational costs that keep the hospital running 24 hours a day, 365 days a year.
- Each hospital’s cost and charge structure vary for a variety of reasons including patient complexity; types of services offered; local labor cost; supply and equipment cost; buildings, utility, and maintenance cost; community service programs offered; and other factors.
- Hospitals provide services to meet individual patient needs 24/7/365, provide free or discounted care to low-income patients, and are paid less than cost for services provide to patients covered by governmental insurance programs such as Medicare and Medicaid.
To view the Pricing Transparency File for BCMH hospital, please acknowledge and click the statement below:
Contained in this file you will find information that complies with the pricing transparency requirements prescribed by the Centers for Medicare & Medicaid Services (CMS). In those requirements, hospitals must provide several different types of charging elements. In general, it is useful to create a distinction between two different types of charges that exist in the healthcare industry. The first is “gross charge” that relates to the established prices that are billed to all patients regardless of insurance coverage. The second is “negotiated charge” that relates to prices insurance companies have agreed to pay for services. All patients will receive the same “gross charge” for items and services at the hospital, however, “negotiated charge” will vary based on agreements that exist with insurance companies. If a patient is insured, he or she will typically be responsible for a portion of the negotiated charge. The portion of the charge that an uninsured or insured patient will pay a hospital for services is referred to as “out of pocket” expense. An insured patient’s out of pocket expense will be dependent on the type of coverage the patient has with the insurance company. Uninsured patients should contact a hospital representative to assist with options for payment. The CMS hopes information from this file can be utilized by researchers and developers to better understand hospital charges for purposes of enhanced transparency and communication. Individual patient responsibility can be discussed by contacting hospital or insurance representatives.nderstand that GROSS CHARGES contained in the chargemaster may not reflect what I actually pay for services received.