St. Clair Hospital’s view of Federal Price Transparency Requirements
In 2018, the Center for Medicare and Medicaid Services (CMS otherwise known as Medicare) established a requirement that, as of January 1, 2019, hospitals must make available a list of current standard charges via the Internet in a machine readable format (i.e. one easily integrated into a computer system or statistical program). Previously, Medicare required hospitals to provide charges upon request. Payments by Medicare, and most insurers, are not based on charges, but on predetermined fixed amounts based on either diagnosis or procedure. The insurance allowed amount and the amounts you owe (deductible and co-insurance) are determined by your insurance plan benefits. St. Clair’s online Patient Estimate tool provides an accurate estimate for your hospital out-of-pocket cost for the majority of elective services, whether you have insurance or not (see example below). You can access Patient Estimates by clicking here and providing basic information.
St. Clair promotes price transparency and applaud Medicare’s intent to promote pricing transparency. St. Clair complies with the Medicare requirements and you can access a list of standard charges in a machine readable format with a brief description by clicking here to view Hospital Charges. Healthcare payment is very complex and we strive to provide information that you find useful. Whether you have insurance or not, should you wish to know your out-of-pocket costs, please access Patient Estimates by clicking here and providing basic information. You may also call our financial counselors at 412.942.8228 for additional assistance to estimate your out-of-pocket cost for services.