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Legal Notice
Estimate Only
This patient-share estimate is an estimate of your costs and is not a contract or guarantee of the actual costs for the services that may be provided to you. Your final out-of-pocket costs may be greater than the amount of this estimate. This estimate is calculated based on the healthcare services, hospital location, and health insurance plan you selected, along with any deductible, coinsurance, and out-of-pocket cost information you inserted into Ascension's price estimator. A hospital visit or encounter might include multiple items or services and might vary from patient-to-patient for the same primary service depending on any complications, length of stay, or services provided due to the patient's health status. Your actual costs may vary depending upon the hospital location, the actual services provided, and timing of other outstanding payments affecting your deductible or out-of-pocket costs. You are encouraged to consult with your insurance provider to confirm your payment responsibilities, deductibles, and other details of your insurance plan. In addition, you may incur other charges from physicians and other healthcare providers separate from the hospital charges for the services identified in this estimate. The other charges could include pathology, radiology, anesthesia, emergency care, and other physician or surgeon charges. Physician-related charges are billed directly by your physician, and other third-party charges (charges for services by providers other than the hospital and your physician) are billed directly by the third-party provider.
Prices Subject to Change
The prices on which this estimate is based are subject to change at any time without notice.
Subject to Medical Necessity
Nothing in this patient-share estimate may mean the selected services are medically necessary or appropriate. Ascension may refuse to provide any services that are not medically necessary or appropriate or violate our Ethical and Religious Directives.
Prior Authorizations; Personal Financial Obligation
Ascension has not obtained any prior authorization or referral that may be required by your health insurance plan for any services identified in this estimate, and Ascension has not contacted your health insurance provider to confirm the costs that will be covered by your insurance plan. You are responsible for getting any prior authorizations and referrals that your health insurance plan requires. You are responsible for contacting your health insurance plan to confirm the costs that will be covered by insurance and any costs for which you will be personally responsible for paying. You will be subject to personal financial obligation for all charges for services performed by Ascension and any other provider whose services are related to or associated with those services. You are responsible for promptly paying any costs not covered by your insurance company.
Definitions and Additional Information
If you have insurance coverage, your financial responsibility will be determined by the contract between the hospital and your insurance company, and the specific coinsurance, copay, and deductible obligations you have under your insurance policy. Below are brief descriptions of some of the key terms used in the estimate above.
- “Copayment/Copay” is a specific dollar amount you pay to receive services such as office visits. This amount is owed regardless of your deductible or out-of-pocket maximum.
- “Deductible” is the amount you pay each year before your health insurance plan begins paying claims. Copays are not included in your deductible.
- “Coinsurance” is the amount (usually a percentage of the in-network rate) for which you are responsible to pay after you have met your deductible.
- “Out-of-Pocket Maximum” is the maximum dollar amount that you will pay per year before the plan begins paying covered expenses at 100%.
- “In-Network Rate” is the rate the applicable hospital has negotiated with the health insurance plan you selected.
- “Out-of-Network Rate” is the allowed amount of reimbursement the health insurance plan you selected allows for the applicable hospital. The hospital is not a participating provider with the health insurance plan you selected.
- “Estimated Insurance Coverage” is the estimated amount of the in-network or out-of-network rate that will be paid by your health insurance plan.
- “Your Estimated Price” is the estimated amount of the in-network or out-of-network rate for which you will be personally responsible for paying.
- “Minimum Negotiated Plan Price” is the lowest rate the applicable hospital has negotiated with all health insurance plans for the applicable service.
- “Maximum Negotiated Plan Price” is the highest rate the applicable hospital has negotiated with all health insurance plans for the applicable service.
- “Self-Pay Price” is the rate the applicable hospital charges patients who do not have insurance.
