As of January 2019, The Centers for Medicare and Medicaid Services (CMS) requires all hospitals to provide pricing transparency. This new requirement is designed to allow patients a clear understanding, prior to an elective procedure, of what their financial obligation will be. This provides a better understanding of hospital pricing, billing and insurance coverage so patients can make informed decisions about their healthcare.
If you have health insurance, contact your individual insurance company to discuss what portion of the procedure expense will be covered by insurance and what portion will be your responsibility. The contact information for your insurance company should be on the back on your insurance card. Your insurance company representative can answer questions related to necessary pre-authorization for elective procedures and coverage of expenses, as well as anticipated out-of-pocket expenses.
After your procedure, it is common to receive separate bills from your personal physician, as well as from other healthcare providers and services (i.e. radiology, anesthesia, pathology) that were involved in your care. If you have questions about these bills, call the phone numbers listed on the individual bills for a complete explanation of charges.
If you do not have insurance and are considered self-pay (patients with no insurance), IRS Regulation 501(r)(5)(A) limits the amount charged for emergency or other medically necessary care provided to individuals eligible for assistance under the organization’s FAP to not more than the amounts generally billed to individuals who have insurance covering such care. This structure represents a 66% discount of charges. Prior to your procedure, contact NARMC by calling 870-414-4007 and selection Option 5 to discuss expected cost and payment options. We have plans to meet most situations, including financial assistance.
The two steps below can help you plan for upcoming medical procedures and the expense associated with that care.
1) Know what procedure you need.
You will need to know the name of the procedure you will be having. Typically, this information can be found on the procedure/test order; however, if you do not have that information sheet, call your physician’s office for the details you need.
2) Determine the estimated cost.
There are two primary ways to do this:
a. Contact your insurance company by calling the phone number on the back on your card. This is especially important for elective procedures. All plans are different, which means out-of-pocket expenses can be different. The Affordable Care Act requires health insurance companies to provide pricing information to their customers, including both the hospital portion and physician services.
b. If you do not have insurance, contact NARMC at 870-414-4007 and select Option 5 to discuss expected costs and payment options.
NARMC never wants cost to stand in the way of necessary healthcare. We recognize cost does play a part in decisions. We have a variety of programs designed to assist patients who cannot afford or have trouble paying medical bills. If that is a concern for you, call 870-414-4007 to discuss these programs.
As part of the 2019 CMS requirements, NARMC is required to provide a Charge Master listing of charges. Click here to view and download the full Charge Master list.
To help you understand the estimated total charges, the below examples reference the average charges for common procedures.
DRG Standard Charges: Diagnostic Related Group is a system that Medicare and some health insurance companies use to categorize hospitalization cost. The average standard charge by DRG is calculated by a weighted average based on length of stay, increased by 5% to account for the recent price increase. The average charge by DRG will vary based on length of stay, procedures performed, etc. driven by the complexity of the particular visit.
Click here to view the NARMC DRG List for inpatient procedures.