Stormont Vail Health understands that hospital pricing and charges can be complex and difficult to understand. We are committed to providing patients and family members with information to help understand hospital charges.
What You Should Know When Looking at Charge Information
What a patient owes for a hospital procedure or service can vary greatly, depending on health insurance coverage, eligibility for state or federal programs, and each individual’s own personal situation.
If you have health insuranceHealth insurance will pay for many of your health services, but not all of them.
- Begin by contacting your insurance company to understand your insurance policy’s deductible, co-payment, coinsurance, and maximum out-of-pocket levels.
- To avoid out-of-network penalties, check to see if you are required to use hospitals that are in your insurance company’s network.
- In addition, ask if you need to obtain pre-certification or referral approvals prior to your hospital service. This will help you avoid your policy’s penalties and additional amounts owed when the required approval is not obtained.
- Some insurance companies negotiate discounts with hospitals on behalf of the patients they insure. The discounts will vary among insurance companies, and are not reflected in the charge list.
If you have MedicareMedicare will pay for many of your health services, but not all of them. Medicare does not pay hospitals based on charges, but instead pays according to pre-established rates depending on the services you receive. Your Medicare deductibles and coinsurance are also pre-established based on the services you receive.
- If you have a Medicare supplemental insurance policy, it may pay all or a portion of your Medicare deductibles and coinsurance.
- Special rules apply if you or your spouse has health insurance coverage through your employer.
- Special rules also apply if you have coverage through a Medicare Managed Care plan. Contact your Medicare Managed Care plan to understand your deductible, co-payment, coinsurance and maximum out-of-pocket levels. To avoid out-of-network penalties, check to see if you are required to use hospitals that are in the Medicare Managed Care plan’s network.
- You can contact Medicare at www.medicare.gov.
If you have Medicaid or Medicaid Managed Care planMedicaid will pay for many of your health services, but not all of them. Medicaid does not pay hospitals based on charges, but instead pays according to pre-established rates depending on the services you receive.
- A few services have minimal pre-established co-pays that are your responsibility to pay. Co-pays will not apply if you are in a Medicaid Managed Care Plan.
If you are uninsuredIf you have a financial need, a variety of financial assistance options are available that may help pay all or a portion of your hospital charges. In some cases, you will be asked to provide income and other asset information to determine whether or not you qualify for full or partial financial assistance.
- To obtain more information, please call Customer Service at (785) 354-6130. If you are located outside of the Topeka area, call (866) 327-3475. For more information on financial arrangements, click here.
Request a Price Estimate
Customer service representatives are available to assist you with estimating your potential hospital charges. The more detail you provide about your procedure, the better estimate we can provide. If you can, please obtain procedure codes or CPT (current procedural terminology) codes from your ordering physician for the best estimate.
Contact Customer Service for Price Request
Monday through Friday, 8 a.m. to 5 p.m.
If you have health insurance, we may be able to provide an estimate of your out-of-pocket responsibility. Availability of this service is dependent on your insurance company being able to provide us with up-to-date benefit information prior to your service. For the most accurate information, check with your insurance company on your coverage. For your convenience, a list of Kansas Insurance Company phone numbers and websites is available here.
Examples of Common Hospital Charges
Charge information is for informational purposes only and should not be used as the sole basis for making health care decisions. Average charges shown are based on data for the most recently reported four calendar quarters. The current average charges may be different because charges for very recent services are not yet available.
- “Charge” is not the same as what you may owe. “Charge” is the amount billed for a service. This may be billed to your insurance, Medicare, Medicaid, or directly to the patient if the patient does not have third-party insurance.
- A patient’s amount due is based on insurance coverage and allowance, deductible, co-insurance, and co-pay. If a patient is uninsured, they may qualify for financial assistance. To find out if you qualify, contact customer service at (785) 354-6130.
- All professional charges (surgeons, radiologists, anesthesiologists, pathologists, and emergency room physician, etc.) are billed separately and are not included in the average charges shown.
- Because each person’s health needs are different, the average charges shown will depend on the individual’s specific situation. Each patient’s circumstances are different, and a patient’s charge will not necessarily be the same as the average charge.
Note: Hospital pricing does not include charges from Cotton O’Neil clinics or provider charges.
Inpatient Estimates by Diagnosis-Related Group (DRG)
A DRG, or Diagnosis Related Group, is a broad classification of an inpatient stay that is defined by a surgical procedure, diagnosis, or age. On this DRG list, you will find an average charge, minimum charge, and maximum charge based on Stormont Vail’s past annual inpatient volume data. This list can be used to give an idea of what your insurance may be billed, but is not necessarily what you will pay.
Hospital & Pharmacy Charge List
“Charge” is not the same as what you may owe. “Charge” is the amount billed for a service. A patient’s amount due is based on insurance coverage, copay, and co-insurance. If a patient is uninsured, they may qualify for financial assistance.
Tips and Disclaimers
- Prices listed as $0 or $1 indicate that the actual charges will be determined at the time of service.
- For more information on a specific charge on the Hospital Charge list, look up the first 3 digits of the Charge Item number in column A, in the Chargemaster Key tab in the same file.
- Pharmacy prices can be volatile and can change frequently throughout the year. Prices listed here are a snapshot of prices at the time of posting and can vary from what you are billed.
Hospital Pricing Resources
These guides from the Healthcare Financial Management Association are designed to help consumers understand where to get answers to their questions about health care prices, compare prices among providers, and manage their out-of-pocket costs.
- Understanding Health Care Prices
- Comprensión de los precios de la salud
- Avoiding Surprises in Your Medical Bills
- Cómo evitar sorpresas en sus facturas médicas