Cost of Service
There are several components that go into determining your total out-of-pocket cost for your health care; for example, do you have insurance, what type of coverage do you have, do you have a secondary or supplemental insurance, is the care being provided a covered service under your insurance, is the service authorized by your insurance carrier, and more.
You play a major role in ensuring that your health insurance will cover the services received. You should always ask your insurance carrier and make sure the procedure or service your health care provider has ordered is a “covered service”. If it is covered, check to see if that service requires an authorization or pre-certification. If it does require an authorization or precertification, check with your provider and/or health care provider or facility to make sure the required authorization or pre-certification has been obtained.
Get an Estimate
The way to get the most accurate estimate of what you would owe for your procedure or service is to contact a Floyd representative by calling 706-509-3277. Our representatives can help you get an estimate of what you would owe based on the information you provide.
Information Needed for Estimate
When requesting a price estimate, we will need several specific items to calculate the most accurate estimate possible. These include the following:
Patient date of birth
Insurance name and subscriber number (available on your insurance card)
All procedures to be performed and diagnosis (available from your provider). Having all procedures that will be performed will ensure a more accurate estimate of your out of pocket responsibility.
We will be able to give you an estimate based on your individual insurance coverage and procedures scheduled to be performed.
An important reminder, this estimate is for the hospital charges only. Our estimate does not include your physician, the anesthesiologist, pathologist, radiologist, or other specialist involved in your care. You will receive bills directly from those providers if they perform any services for your care. The estimate does not cover any unforeseen costs related to your care, such as medical complications, additional services that were performed that were unknown at the time of the estimate, or any special accommodations or considerations that were necessary.
Where to view Standard Charges and Shoppable Items?
Pricing information is available to allow you to estimate cost of a particular service. The information provided for Standard Charges and Shoppable Items should help you compare prices from hospital to hospital. It is unlikely that your final bill will exactly match the prices listed and may serve only as an estimate of the final cost.
Medicare has defined several different types of standard charges that should be available for patients to see. They are:
- Gross charges
- Discounted cash price
- Payer-specific negotiated charge
- De-identified minimum negotiated charge
- De-identified maximum negotiated charge
Download the Understanding Pricing Guide (pdf) for more details and a a quick overview of each standard charge found in the Chargemaster.
View Standard Charges and Shoppable Items by clicking the facility name:
Calling your insurer is always a good idea if you're considering an elective procedure and want to get a general idea of your out-of-pocket costs. Your insurer can help you understand how your coverages and deductibles work as well as your current payment history as an essential first step.
What if my service is not covered by insurance or I don't have any insurance?
Private pay is when you, as the patient, do not have any insurance coverage, or your insurance does not cover the service or procedure (“non-covered service"). In either case, you are responsible for payment of the bill. We offer two discounts in these cases.
- Pay full payment within 12 months from initial billing and receive a 35 percent discount. The discount is applied once 65% of the bill has been paid.
- Pay full balance due within 30 days of first billing and receive a 20 percent discount in addition to the 35 percent discount.
If you are interested in a payment plan for your services, please call 1-706-509-6000 or 1-866-874-2772 to speak to a customer service representative. They can also assist with financial assistance. Unpaid claims will be referred to collections. For more information view financial assistance policies.
What are claims, bills, and reimbursement?
After you have been discharged your insurance company will be sent a claim for your services. There are times that once the carrier receives the claim, they may reach out to you for some additional information before they make payment. For example, if they believe this could be due to an accident, they will want to gather information about the accident and any other possible coverage. It is very important to respond in a timely manner. Not doing so, could result in your claim being denied leaving you responsible.
It can take 30 to 60 days for an insurance company to pay the claim once they have all the information they need to process the claim. Once the facility is paid by the insurance company, you will be sent a statement for any balance owed by you. If you paid any amounts up front, that will be reflected in your statement. If by chance the estimate was more than you owe, and you did pay up front, we will process a refund to you.
If you are interested in a payment plan for your services, please call our offices at 1-706-509-6000 or 1-866-874-2772 to speak to a customer service representative. They can also assist with financial assistance. Unpaid claims will be referred to collections.
How do insurance carriers pay the claim for a covered service?
Insurance reimbursement depends on your payor source (insurance company, Government, or private payment) and your individual insurance plan.
Government payors typically pay on a pre-determined fixed schedule and is dictated to the hospital by the Government entity; it is not negotiated. Medicare, for instance, pays inpatient hospital stays on a fixed payment schedule based on Diagnosis Related Group (DRG) regardless of what the hospital charges. The patient is responsible for an In-patient Deductible. If the patient has a supplement or second insurance, that insurance may cover part or all the remaining deductible amount depending on the plan. Outpatient services are paid on a separate schedule from inpatient services. For outpatient services, the patient is responsible for both a deductible and co-insurance. Again, if the patient has a supplement, the other insurance may pay part of the co-insurance.
Medicare Advantage plans or Medicare Replacement plans tend to reimburse more like commercial (non-government insurance plans) payors and have many restrictions on coverage, so it is very important to insure your procedure or service is a covered service and authorization and/or pre-certification has been given by the plan. These plans may also have restrictions on what hospitals and physicians are “in network” (meaning they will cover the service or procedure at that facility or with that physician).
Commercial payors contract with hospitals to care for their customers. Hospitals are paid the insurance company’s contract rate, which is significantly less that the amount listed in the chargemaster. The insurance company’s contract rate, not the chargemaster, is the basis for determining the patient’s actual out-of-pocket costs.
For example, a hospital may charge $1,000 for a specific service, while the insurer’s contracted rate may be $700 (also known as the allowable amount). If the patient’s insurance plan indicates the patient is responsible for a 20 percent co-insurance, the patient would owe $140 ($700 x 20%). If the patient has a secondary insurance, the secondary coverage may pick up at least part of the deductible, co-payment or co-insurance.
What is a Chargemaster?
A chargemaster is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital – each test, exam, surgical procedure, room charge, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a chargemaster contains thousands of services and related charges.
The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted reimbursement rates to the services that are billed, known as allowable amounts. In situations where a patient does not have insurance, our hospital provides uninsured discounts and has financial assistance policies that can provide free or discounts to lower the actual amount owed by the patient. For more information view financial assistance policies..
View the chargemaster for Polk Medical Center
Are charges the same for every patient?
Each service or item charged is the same charge amount. However, each person and each procedure may involve many differences and therefore the total charges could vary between two people having the same procedure. For example, the causes for a different tptal charge for a surgical procedure would include, but not limited to, the following:
- How long the procedure and recovery take
- The medications that are required during and after your service
- If there are complications that must be addressed in your care
- Additional treatments that may be required
- Each person's underlying health conditions