What is a hospital chargemaster?
The federal government requires hospitals to post certain information about charges and their negotiated insurance ratesfor their services. Healthcare insurance companies negotiate rates with the hospitals and pay based on these contracted rates regardless of the charge amount. Negotiated rates may include a portion you are directly responsible for, such as the deductible, coinsurance or co-pay, as well as charges for services not covered by the insurance policy. These rates vary between different health insurance companies. Below please find the chargemaster and the Hospital’s negotiated insurance rates in a machine readable format:
It is important to note:
- The chargemaster reflects a point in time. It does not include discounts resulting from financial assistance or the patient’s ultimate potentially payment responsibility.
- It does not provide a quote or guarantee of actual charges e.g. how much it will cost for a specific patient’s care
- It does not account for any variables in patient’s medical condition, complication, length of stay, use of laboratory tests, physician fees, or separately reimbursable medical supplies, devices, or pharmaceutical, etc.
What is a Diagnostic Related Group?
Diagnostics Related Groups “DRGs” is a payment mechanism used by Medicare and some other insurers to reimburse Hospital’s for an Inpatient Stay. DRG’s are categories of care where regardless of the charges, the Hospital is reimbursed based on a specific fee schedule. This document is a listing of the average “charge” per DRG. This file does not represent the actual reimbursement from the insurance company, but the average charge per DRG.
PATIENTS SHOULD ALWAYS CONTACT THE HOSPITAL’S BILLING DEPARTMENT FOR ANY SPECIFIC INFORMATION OR ESTIMATES REGARDING THE COST OF YOUR CARE AND SERVICES AT THE HOSPITAL.
What is the Chargemaster and Diagnostics Related Group (DRG) impact on your Bill for care
When you receive a bill for your care from Griffin, you may see the full price for the service and supplies based on the Hospital chargemaster.
Insurance companies work with hospitals to negotiate discounts on prices/charges (including inpatient DRG’s) for their customers. If you have insurance, you may see an adjusted price/charge. This reflects the discounted amount your insurance company negotiated with Griffin Hospital. Your insurance company is usually billed first and a second billing detailing your responsibility will be sent to you soon after the Hospital receives the insurance payment. This second bill will reflect an adjusted amount called the “allowable amount” which reflects the combined insurance and patient amount to be paid. Any remaining balance after the insurance payment amount is either due by you or a “secondary insurance” company.
If you have been approved for financial assistance, the Hospital bill will reflect the full chargemaster price for your services less any financial assistance discounts.
If you have any questions or concerns in regards to your bill, please call the Patient Accounting Department at 203-732-1510, Monday through Friday from 8:30 am to 5:00 pm.