What Main Line Health is doing to be transparent on pricing
Main Line Health is committed to complying with Federal laws requiring price information be made available to the public.
Widespread variation in health insurance plans and associated benefits make it difficult for hospitals to provide specific cost information without access to very detailed information about a patient’s health insurance coverage.
Main Line Health is investing heavily to make cost information more accessible. For example:
- In accordance with IPPS, Main Line Health hospitals will be publishing its chargemaster on January 1, 2019.
- Dedicated financial counselors are located at each hospital to assist patients with understanding and calculating their financial responsibility.
- Main Line Health hospitals has a comprehensive Financial Assistance & Charity Care Policy.
- Charity Care (free care) is offered to patients who qualify.
- Extended payment arrangements can be made under most circumstances.
- A dedicated Patient Estimation team is in place to help patients proactively understand their financial obligation.
- Use of Epic’s MyChart portal as a means of communicating price information to our patients is in development stages.
Frequently asked questions about pricing transparency
What is a chargemaster?
A chargemaster is a comprehensive list of charges for each inpatient and outpatient service provided by a hospital or health system—each test, exam, surgery, procedure, room charges, supplies, etc. is an entry within a health system or hospital’s chargemaster.
- Given the broad scope of services provided by hospitals every day, a chargemaster contains thousands of items and services with their associated charges.
- Health insurance companies contract with hospitals to care for their members. Hospitals are paid the insurance company’s contracted rate, which generally is significantly less than the amount listed on the chargemaster.
- An individual hospital’s charges vary based on its unique range of services, adoption of new medical technologies, government underfunding, patient demographics and other local and regional factors.
- The insurance company’s contract rate, not the chargemaster, is the basis for determining the patient’s actual out of pocket cost. As an example, a hospital may charge $1,000 for a particular service. The insurer’s contract rate may be $700. The patient’s insurance plan indicates the patient is responsible for 20 percent of the contract rate, the patient would owe $140 ($700 x 20 percent)
What is not included in the chargemaster?
Main Line Health’s chargemaster does not include services provided by doctors who treat you while you are at the hospital. You may receive separate bills from the doctors involved in your care. A partial list of the healthcare providers who may bill you separately include:
- Your personal doctor
- The surgeon who performs your procedure
- The anesthesiologist
- The radiologist who reads your x-rays or other imaging studies such as an MRI or CT scan
- Other physicians who may have been asked to provide a consultation during you time in the hospital
Are charges the same for every patient?
The list of charges is the same for all patients. However, total charges for an individual patient often vary from one patient to the other for a number of reasons to include the following:
- How long it takes to perform the service or how long it takes you to recover in the hospital
- Whether the service you receive is more or less difficult than expected
- The kinds of medication you require
- Whether you experience complications or require additional treatment
How is cost information shared with patients and families?
The chargemaster is not a useful tool for consumers who are comparison shopping between hospitals or health systems.
- Main Line Health employs financial counselors and other resources to help our patients understand their financial obligations.
- We encourage patients to reach out and ask detailed financial questions, especially before scheduled services.
- Main Line Health is ready to help patients and their families understand their financial obligations at any time during the treatment process.
Are charges different from payments?
Yes, charges are different from payments.
- Chargemaster amounts are almost never billed to a patient or received as payment by Main Line Health.
- The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted rates to the services that are billed. In situations where a patient does not have insurance, our hospital has financial assistance policies that apply discounts to the amounts charged.
- Every insurer pays Main Line Health differently. Medicare and Medicaid generally pay less than the actual cost of caring for patients.
- There are also patients who, unfortunately, can’t pay their hospital bills. Main Line Health treats uninsured and underinsured patients every day.
Where can I find more information about hospital costs?
Patients can find more information about the chargemaster, what your care will cost you or Main Line Health’s Financial Assistance Policy by visiting mainlinehealth.org/patient-services. You may also contact the Patient Estimate team at 484.337.1970.
*The attached file contains standard charges for items, procedures and services provided by Main Line Health hospitals (Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital, Riddle Hospital and Bryn Mawr Rehabilitation Hospital), also known as a chargemaster. Your billed amount may vary depending on whether you have insurance, the terms of that insurance, whether your insurance provider has a contract with Main Line Health, your eligibility for Main Line Health financial assistance programs, and other factors. The attached rates may not include ancillary charges made by physicians and others who bill separately for professional services. The standard charges file is not a helpful tool for comparison shopping between hospitals or to estimate what health care services are going to cost you out of pocket. If you have questions or concerns regarding our standard charges or would like to request an estimate, please contact the Patient Estimate team at 484.337.1970.