The patient-share estimates generated using Ascension's price estimator are estimates of your costs and are not contracts or guarantees of the actual costs for the services that may be provided to you. Your final out-of-pocket costs might exceed the amount set forth in any estimate generated using Ascension's price estimator. Estimates generated using Ascension's price estimator are calculated based on the healthcare services, hospital location, and health plan you select, along with any deductible, copayment, coinsurance, and out-of-pocket cost information you input into Ascension's price estimator. A hospital visit or encounter might include multiple items or services and may vary from patient-to-patient for the same primary service depending on any complications, length of stay, or treatment provided due to the patient's health status. Your actual costs may vary depending upon the hospital location, the actual services provided, variation in complexity, and timing of other outstanding payments affecting your deductible or out-of-pocket costs. You are encouraged to consult with your health insurer to confirm your payment responsibilities, deductibles, and other details of your insurance. In addition, you may incur other charges from physicians and other providers separate from the hospital charges for the services identified in any estimate generated using Ascension's price estimator. 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 will be billed directly by the third-party provider.
Prices Subject to Change
The prices set forth in any estimate generated using Ascension's price estimator are subject to change at any time without notice.
Subject to Medical Necessity
Nothing in any estimate generated using Ascension's price estimator may be construed as a determination that 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 any estimate generated using Ascension's price estimator, and Ascension has not contacted your health insurance plan to confirm the costs that will be covered by your insurance plan. You are responsible for
- obtaining any prior authorizations and referrals that your health insurance plan requires;
- 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;
- any 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; and
- 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 estimates generated using Ascension's price estimator.
- “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%. If your benefits are part of a family plan, your family out of pocket may reduce your deductible or coinsurance.
- “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.
- “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.
Compliance with Price Transparency Rules
The Ascension's easy-to-use price estimator is intended to comply with the CMS price transparency rules set forth at 45 C.F.R. § 180.60. To access payer-specific negotiated rates, please select the applicable payer and plan in this price estimator. To access the discounted cash prices, please select the "Proceed Without Insurance" option under the payer drop-down menu. The minimum and maximum payer negotiated rates are included in all estimates generated using Ascension's price estimator.