Price Transparency

Charges are set by the hospital based on the total direct costs – professional fees, staffing, supplies, equipment – and indirect costs – administration, medical records, billing, housekeeping, maintenance, facility expenses, etc. – of providing the service.  Often, charges are also compared to charges established by other hospitals and clinics in the region to help ensure they are comparable.

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Charges can be hard for patients to understand because they reflect:

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• the direct services the patient actually experiences,
• ALL the things that happen behind the scene that make those services possible,
• AND the cost of making those services available 24-hours-a-day, 7-days-a-week, 365-days-a-year.

North Runnels Hospital is seldom – if ever – paid the full amount of billed charges.

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The hospital negotiates payment rates with every major insurance company that provides coverage to residents in our community.  As part of that negotiation, the insurance company typically establishes an “allowable” rate for each item or service, and then further establishes a discount from that “allowable” rate that they will pay, minus any deductibles, coinsurance and co-pays that the insurance company indicates are the patient’s responsibility.  This “allowable” rate typically falls well below hospital charges.

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If the insurance company refuses to contract with the hospital, or the hospital is unable to negotiate a satisfactory contract with the insurance company, North Runnels Hospital may be considered “out-of-network” with that plan.  The insurance company may then chose not to pay for the services you receive at an “out-of-network” hospital, increasing your out-of-pocket payments.

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It is likely that your insurance company has negotiated different payment rates with each hospital under contract.

Deductibles vary by insurance company, from as little as $500 per year to $10,000 or more per year, and reflect the plan you or your employer selected and the premium paid for that coverage.  Lower deductible plans typically have higher monthly premiums, while higher deductible plans have lower monthly premiums.   The deductible is the amount you will pay each year before you receive full benefits from your insurance company.

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Established by your insurance company and plan, coinsurance is a percentage of the “allowable charge” that you will pay after you have reached your deductible.  Also established by your insurance company or plan, co-pays are a flat fee you pay for a health care service.  Co-pays can take effect either before or after your deductible has been met, and may not apply to all services.

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Information about your deductibles, coinsurance and copayments are available from your insurance company or employer.

Medicaid pays all hospitals based on the same fee schedule.  You can view the fee schedule or lookup a Medicaid fee by going to the Texas Medicaid & Healthcare Partnership website:

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http://public.tmhp.com/FeeSchedules/Default.aspx

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For Rural Health Clinic services, Medicaid pays North Runnels Clinic on a cost-based calculation.

As a federally designated Critical Access Hospital, traditional Medicare pays North Runnels Hospital based on the actual cost of providing care to Medicare patients.  If you have a supplemental plan or Medigap coverage, it will cover some or all of your deductible, coinsurance and co-pays.  You will need a separate Medicare Part D plan to secure insurance coverage of drugs.

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If you have enrolled in a “Medicare Advantage Plan” you no longer have traditional Medicare.  These “Plans” are offered by private insurance companies and have different monthly premium, deductibles, coinsurance and co-pays.  Some of these plans will include drug coverage, but you cannot buy a Medigap policy.

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Again, information about your deductibles, coinsurance and copayments are available from the insurance company that sold you the “Medicare Advantage Plan.”

Uninsured or underinsured patients should consult with our business office staff at (325) 754-4553 or come by to speak to one of our business office representatives to determine whether or not they qualify for discounts.

If you have further questions about the North Runnels Hospital CDM, please contact our hospital business office at (325) 754-4553 or come by and speak to one of our business office representatives.