Cost for Care
Each patient is unique in their healthcare needs and insurance coverage. Although it is difficult to provide specific cost information, Holyoke Medical Center is committed to providing as much cost transparency as possible. If you have questions about the cost of your healthcare needs, we encourage you to please call the Holyoke Medical Center Patient Fianancial Obligation Inquiry Line at 413.534.2871.
What is a Hospital Chargemaster?
A hospital chargemaster is a comprehensive list of all billable services and items provided by a hospital. Chargemaster amounts are almost never billed to a patient or received as payment by a hospital. The chargemaster amounts are billed to an insurance company (payers). These payers then apply their reimbursement terms or contracted rates t the services that are billed. If a patient co-pay, co-insurance, or deductible is owed, these too are most often not based on chargemaster amounts but rather the payment terms determined by the payer.
What is NOT included in the Chargemaster list?The hospital’s chargemaster may not include charges for services provided by the doctors who treat you while you are at the hospital. You may receive separate bills from the hospital and the doctors involved in your care. The following provides a list of providers who may send a separate bill for any services provided in the hospital
- Your personal doctor, if he/she sees you in the hospital
- The surgeon who performs the procedure
- The anesthesiologist who works with the surgeons.
- The radiologist who reads your x-rays or other imaging
- Other doctors who may be consulted by your doctor during your time in the hospital
What is a Diagnostic Related Group (DRG)?
Any of the payment categories that are used to classify patients, especially Medicare patients, for the purpose of reimbursing hospitals for each case in a given category with a fixed fee regardless of the actual costs incurred and that are based especially on the principal diagnosis, surgical procedure used, age of patient, and expected length of stay in the hospital.
The maximum amount a provider bills for a specific healthcare service before the application of any discounts, rebates, negotiations, or other forms of charges reduction or adjustment and regardless of payer.
Commonly referred to as CDM, or Charge Description Master, means a comprehensive list of all billable services and items provided by a hospital. It captures the costs of each procedure, service, supply, prescription drug, and diagnostic test provided at the hospital, as well as any fees associated with services, such as equipment fees and room charges. Because hospitals operate 24 hours a day, seven days a week, a chargemaster can contain thousands of services and related charges.
The amount of covered benefits that the patient is responsible for paying after reaching his or her deductible amount. For example, if your co-insurance is 20 percent of medical costs, and your bill totals $100, you pay $20 and the insurance company is responsible for $80.
The fixed amount of out-of-pocket costs you pay when visiting the doctor’s office for a particular healthcare service. One example is a visit to your primary care doctor. If your co-pay is $20, that means you pay $20 per visit regardless of the reason for seeing your doctor, and your insurance company pays the rest.
The amount you owe for healthcare services before your health insurance plan begins to pay. For example, if your deductible is $100, your health insurance won’t pay anything until you’ve met your $100 deductible for healthcare services. Your deductible may not apply to all services, for example, some plans offer yearly mammogram or physical exam free of charge.