The information provided in Pricing
can help you better understand how the procedures and conditions you selected in PricePoint translate into actual health care services – and how those
services contribute to the charges you might see on your bill or in a report from your insurance company.
Of course, every patient is different. The actual charges will vary depending on your unique health situation, the specific providers that treat you, your insurance, and any financial
assistance you might receive for these services.
Understanding Your Results on PricePoint
It is important to note that some of the charges displayed in Pricing may not be covered by your insurance.
This means that the information displayed in PricePoint should be used as a starting point
for an informed discussion between you, your doctors and your insurance company.
We’ll walk through an example Pricing
page. You can follow along using your own results. While your specific data may be different, the structure will be the same.
There are two parts to the Pricing information you’ve received:
- The first part, located at the top of the Pricing page, includes the estimated hospital charges for the hospital you selected.
- The second part, located at the bottom of the Pricing page includes other services that might be needed as part of your treatment - and the estimated charges associated with those services.
Let’s start at the top with the Estimated Hospital Charges.
In our example, we can see that the hospital we selected - Memorial Hospital – has a median charge for a knee replacement of $32,325 and
that patients that receive a knee replacement at Memorial Hospital can expect to stay in the hospital for an average of 2.4 days.
The numbers shown in your Pricing
information may be different, but you should be able to locate them on your Pricing
page. If, your Pricing
show “NR,” it means there is not enough data
from this hospital for PricePoint to report on the services you are seeking.
In this section we can also see how our chosen hospital compares to other hospitals in Wisconsin. The statewide median charge and the statewide average length of stay are shown in Pricing to
give you a point of reference when examining the information about the hospital you selected.
If you want to, you could use the “compare hospitals” button to select another hospital and see how its charges compare to the hospital you selected and to other hospitals statewide.
It is important to note that the charges shown are not the same as what you will pay.
The amount you actually pay will vary depending on your unique health situation, your insurance, and any
financial assistance you might receive for these services.
It is also important to note the charges shown in this top section of Pricing
are the hospital facility charges only. These charges do not include any professional services, rehab,
medications or other services that you may need. To get a better idea about the other services you might need, let’s look at the bottom section of Pricing – the section titled
“Estimated Other Charges.”
This section provides an overview of the other types of services and charges that may show up on your bill or in a report you receive from your insurance company.
It is important to note that some of these charges may not be covered by your insurance. We encourage you to talk with your insurance company about the services and charges displayed
in PricePoint in order to get a better idea about what your financial responsibility may be.
There are several types of services that are commonly needed when someone has health care. Since these services are not necessarily tied to a hospital, PricePoint provides the statewide average
for these charges.
This may seem a bit confusing, but patients can receive services from a number of different rehabilitation facilities, pharmacies, laboratories and other health care professionals in conjunction
with care that they receive at a hospital. Since there is no way to know for sure where you will receive each of the services you need, providing a statewide average can give you some insight
into what the approximate charge may be for each service.
Let’s go back to our example. In the bottom section of the results, we can see that our example condition – a knee replacement - typically requires the following services:
- Outpatient Services,
- Professional Services,
- Pharmacy Services,
- Rehab or Skilled Nursing Facility Services, and
- Ancillary Services.
A closer look at our example shows that outpatient services
for knee replacements average about $2,529 in Wisconsin. These outpatient services will probably include the MRI needed to diagnose
the knee problem and any other outpatient service needed for treatment.
The professional services
that are typically needed with a knee replacement average about $11,834 in Wisconsin. Professional services could include the services that will be performed by an
anesthesiologist during surgery or services from another health care professional, like a sports medicine doctor, a primary care physician or others.
In our example, it looks like a knee replacement would require minimal charges for pharmacy services.
In Wisconsin, pharmacy services for knee replacements average about $40. This typically
covers any medications that may be needed or any dye that was used in an MRI or other test.
As you might expect, a knee replacement will require some rehabilitation. If these services are performed in a rehabilitation or a skilled nursing facility
the average charge in Wisconsin would
be about $1,738.
And, lastly, a knee replacement might require some ancillary services.
This could include crutches, a wheelchair, a knee brace, or any other medical supplies. It could also include home health
services or transportation services that might be needed to get to and from appointments. In Wisconsin, the average cost for ancillary services would be about $259.
In the end, the average statewide total charges for all of these other services in our example – not including the hospital facility charges in the top part of Pricing - could come to about $16,400.
But again - these are charges – not necessarily what the services cost or what you will be billed.
You might be wondering why PricePoint shows you charges instead of the actual amounts you will be billed.
It is because we don’t actually know where or who will be providing these services to you
– and prices can vary significantly. You may have chosen to go to a specific hospital because you’ve had good experiences there in the past – but that hospital isn’t anywhere near your home town where you’ll be
having your rehab appointments and getting your prescriptions filled. Or, maybe your condition has complicating factors and you need special equipment to help with your healing process.
Because there is so much variability in the costs of these services we have provided the statewide average charges. It isn’t perfect – but it should give you a good starting point for an
informed discussion with your doctors and your insurance company.