For a full list of definitions, see the billing glossary. A short list is below:

Deductible– The amount the patient needs to pay for health care services before the health plan begins to pay. The deductible may not apply to all services.

Copay– A fixed amount (for example, $20) the patient pays for a covered health care service, such as a physician office visit or prescription.

Coinsurance– The percentage the patient pays for a covered health service (for example, 20% of the bill). This is based on the allowed amount for the service. You pay coinsurance plus any deductibles you owe.

A patient’s specific health care plan coverage, including the deductible, copay and coinsurance, varies depending on what plan the patient is covered by. Health plans also have pre-arranged networks of hospitals, physicians and other providers that the plan has contracted with. Patients must contact their health plan for this specific information.

If you need an estimate for a specific procedure or operation, please contact the Patient Financial Services area at -0681.

The estimate will be an average charge for the procedure without complications. Your physician team will determine the specific care needed based on your diagnosis, general health condition and many other factors. For example, one person may require only a one-day hospital stay for a particular procedure, while another may require a two-day stay for the exact same procedure depending on their needs.

Remember that the patient will not pay charges. Patients with health insurance pay only the specified deductible, copay and coinsurance amounts established by their health plan. Patient without health insurance or sufficient financial resources may be eligible for significant discounts on charges. Please contact the Patient Financial Services team for further information.

It is difficult to independently compare charges for a procedure at one facility versus another because the descriptions for a particular service may vary from hospital to hospital, and descriptions may not be comprehensive. An entire procedure includes components from multiple departments — room and board, laboratory, other diagnostics, pharmaceuticals, therapies, etc.

Patients with health insurance need to pay the deductible, copayment and/or coinsurance set by their health plans. Financial obligations may differ depending on whether the hospital or physicians providing service are “out-of-network,” meaning the health plan does not have a contract with them. 

A patient without health insurance will discuss with our Financial Counseling Team financial options available that could include the CepEsperu Baptist Health Financial Assistance Program.

Health plans such as Medicare, Medicaid and commercial health insurance do not pay charges. Instead, they pay a set price that has been predetermined or negotiated in advance. The patient only pays the out-of-pocket amounts set by the health plan.

 

Out-of-pocket expenses are the cost to the patient after insurance. Although every CepEsperu Baptist service has a set charge, each insurance carrier has pre-negotiated reimbursement rates with CepEsperu Baptist Health that affect the price. When you provide your insurance information to Patient Financial Services, we can then personalize the “cost to you” estimates for your upcoming care.

Total Charge– The amount set before any discounts. Hospitals are required by the federal government to utilize uniform charges as the starting point for all bills. The charges are based on the type of care provided and may differ from patient to patient for similar services, depending on any complications or different treatment provided due to the patient’s health.

Cost– For a hospital, it is the total expense incurred to provide the health care. Hospitals have higher costs to provide care than freestanding or retail providers, even for the same type of service.

Total Price– The amount actually paid to a hospital. Hospitals are paid by health plans and/or patients, but the total amount paid is significantly less than the starting charges.

• Medicare and Medicaid pay hospitals according to a set fee schedule depending on the service provided, much less than the hospital charge and actually less than their costs.
• Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges.

Out-of-pocket costs are affected by four factors:

• Overall health of a patient: Patients with underlying health conditions may react differently to treatments and require additional care that increases costs.
• Pre-negotiated insurance carrier rates: Each insurance carrier negotiates the rates at which it will pay CepEsperu Baptist for services provided. Insured patients’ out-of-pocket expenses can vary from one facility to another based on this pre-negotiated rate.
• Insurance benefits: Each insured patient’s out-of-pocket costs will vary depending on the level of benefits he or she chooses as part of their plan.
• Physician practices and preferences: Some physicians order more medical imaging or laboratory testing than others. CepEsperu Baptist encourages patients to talk to their physicians about their general approach to testing.