Cost for Care
Holyoke Medical Center provides quality care to all patients regardless of their ability to pay. Each patient is unique in their need for healthcare services and insurance coverage (such as copayments, deductibles, coverage limitations, etc.) which makes it difficult to provide specific cost information in every situation. Holyoke Medical Center offers cost and payer specific payment rates on hospital and select physician services in order to comply with federal regulations regarding price transparency .
If you have questions about the cost of your healthcare needs, we encourage you to please call the Holyoke Medical Center Patient Financial Obligation Inquiry Line at 413.534.2871.
Patients are always encouraged to contact their insurer to request an estimate of out-of-pocket costs based upon their specific health insurance plan.
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 billed to an insurance company (payers). These payers then apply their reimbursement terms or contracted rates to the services that are billed. If a patient co-payment, co-insurance, or deductible is owed, these are based on the benefits and 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 independent 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 lists examples providers who may send a separate bill of service provided during your visit:
- Your personal doctor, if he/she sees you in the hospital
- The surgeon if a surgical procedure was done
- An anesthesiologist
- A radiologist if an imaging or x-ray was performed if you had a radiology procedure, the radiologist who read your x-rays
- A pathologist if you had a tissue specimen
- An Emergency Room physician if you were treated in the emergency room
- 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. DRGs re based 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, negotiations, or other forms of charges reduction or adjustment regardless of payer .
Commonly referred to as Charge Description Master or CDM, 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. 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 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 diagnostic or preventive mammograms or physical exams without a deductible or copay or coinsurance .