SwedishAmerican believes generating an estimate using our Guest Estimate feature or through your MyChart login, will provide a better value in understanding your potential out of pocket expenses. This tool is found here. If you have questions regarding your cost for a specific service, please contact SwedishAmerican at (779) 696-7150. A financial counselor can review your specific information to provide you with an estimate and/or discuss any financial concerns you may have.
The Centers for Medicare and Medicaid Services (CMS) requires each hospital to post a list of their standard charges—a Charge Description Master (CDM)— in a machine-readable format and update the data at least annually. A standard charge means the regular rate established by the hospital for an item or service provided to a specific group of paying patients. For purposes of complying with the Hospital
Price Transparency Final Rule, this includes five types of standard charges: gross charge, discounted cash price, payor-specific negotiated charge, de-identified minimum negotiated charge, and de-identified maximum negotiated charge. CMS intended that this information would help patients with improved information regarding price transparency.
The CDM and the corresponding standard charges themselves may not provide the appropriate price transparency for the patient as a patient’s out-of-pocket cost is not determined by the standard charges of a hospital alone. The out-of-pocket cost is driven primarily by:
- Any copay, deductible, and/or coinsurance required by the patient’s benefit plan; and
- The negotiated charge that the patient’s insurance carrier will pay the hospital, which is generally less than the standard charges.
- Any patient that is uninsured will pay the discounted cash price.
If you still wish to review the CDM, please understand the following:
- The descriptions in the CDM may not be understandable to the layperson.
- The inpatient total charge amount and reimbursement rates for many procedures is made up of many individual charge items from the CDM.
- Due to variations in individual physician practice patterns, as well as individual patient differences and the potential for unforeseen complications, charges may vary based on the patient’s situation. Payer specific negotiated charges are sometimes not at the charge master item level and therefore we are unable to provide these amounts at this level of detail
What is the price of COVID-19 testing?
In accordance with the CARES Act, SwedishAmerican, A Division of UW Health’s cash price for the COVID-19 test (Bill Code 87635) is $126.
What does the health plan pay?
- Commercial insurers (Blue Cross, United Health Care, etc.) negotiate discounts with hospitals on behalf of their members, and pay hospitals at varying discount levels, much less than starting charges. Medicare and Medicaid pay according to a regulated fee schedule - both pay at much less than what it costs the hospital to provide the service
- Medicare and Medicaid pay hospitals based on pre-set rates varying among individual hospitals. These rates reflect different hospitals costs of providing care, such as trauma, teaching programs, severity of illness and area wages, among other things.
So How Much Will a Patient Pay?
- Patients with health coverage will only pay the deductible, coinsurance or copay required by their health plan. Although hospitals can assist with estimated charge information for the service being sought, the health plan is the best source of information pertaining to what an insured patient will pay.
- Uninsured patients can apply for Financial Assistance Program, which can be applied for by calling Patient Financial Services at 779-696-7150.
- The Illinois’ Hospital Report Card website lists the average charge for over 50 services at individual hospitals for specific services.