Hospital Pricing Transparency
As of January 1, 2019, the Centers for Medicare and Medicaid Services (CMS) required that all hospitals post a comprehensive, online list of standard charges for services and goods that the hospital provides to its patient. The list is intended to help you easily access charge information to improve price transparency.
While we fully support efforts to improve pricing transparency, the list of standard charges was only a starting point in determining the costs associated with your health care. By itself, the list is not the most helpful tool for you to comparison-shop between hospitals or to estimate your financial obligation for the healthcare services you receive.
Your out-of-pocket cost for care is determined by:
1. the agreed-upon rate that your insurance company pays the hospital for the services provided — which are generally less than the standard charges; and
2. the copay, co-insurance or deductible required by your benefit plan.
Individuals without insurance receive a reduced price from the hospital and may also be eligible for financial assistance or charity care.
Therefore, beginning on January 1, 2021, hospitals are also required to make public their standard charges online in two updated ways:
1. A comprehensive machine-readable file that includes all standard charges for all hospital items and services; and
2. A consumer-friendly display of standard charges for ‘shoppable’ services that are grouped with charges for ancillary services that are customarily provided by the hospital. These standard charges must include:
* Discounted cash price: the charge that applies to an individual who pays cash, or cash equivalent, for the shoppable service. If the hospital does not offer a discounted cash price for a shoppable service, the hospital must list its undiscounted gross charge for the shoppable service (and any corresponding ancillary services).
* Payer-specific negotiated charge: the charge that a hospital has negotiated with a third party payer for the shoppable service.
* De-identified minimum negotiated charge: the lowest charge that a hospital has negotiated with all third-party payers for the shoppable service.
* De-identified maximum negotiated charge: the highest charge that a hospital has negotiated with all third-party payers for the shoppable service.
About Your Cost
Even when provided with this information, we recognize that trying to estimate your out-of-pocket costs prior to receiving care can be challenging. For nearly all patients, standard charges have little impact on out-of-pocket costs. Typically, patient costs are driven by their specific insurance plan design – with remaining deductible and coinsurance limits being the biggest factors in determining costs. As such, the most effective way to determine potential costs for services is to work with your insurer and our patient financial services staff. They can review your personal situation to give you the most accurate estimate, which can vary based on:
* the complexity of your treatment plan;
* the insurer or payer that will be paying for the healthcare services we deliver;
* the length of time you spend in the hospital;
* additional tests or procedures needed; and
* any other unforeseen conditions or circumstances that arise during your care or recovery
Our staff can be reached at 570-348-1364.
Below, for your reference, are the required files as previously described:
Shoppable Services
Disclaimer: Please note, the information provided is not a guarantee of final billed charges. Final billed charges may vary from the estimate set forth in the file for many reasons, including, but not limited to, your medical condition, unknown circumstances or complications, final diagnosis, and recommended treatment ordered by your provider. Professional fees, such as physician, radiologist, anesthesiologist, and pathologist fees may not be included in this estimate. Insurance benefit information (where applicable) is based on either information provided by your insurance company (when available) or historical claims data. Benefits and eligibility are subject to change and the information provided herein is not a guarantee of payment. If your insurance plan has limitations as to where laboratory, radiology, or physical/occupational/speech therapy can be provided, you should contact that provider to obtain an estimate for those services.
Allied Services Institute of Rehabilitation – Shoppable Services (Internet Explorer Users: please download and save the file to open.) The information is current as of December 31, 2020
John Heinz Institute of Rehabilitation Medicine – Shoppable Services (Internet Explorer Users: please download and save the file to open.) The information is current as of December 31, 2020
Allied Services Institute of Rehabilitation - Standard Charges Machine Readable File - The information is current as of December 31, 2020
John Heinz Institute of Rehabilitation Medicine – Standard Charges Machine Readable File - The information is current as of December 31, 2020