Per federal requirements, we have posted our current, standard charges for all procedures. We do want, however, to caution patients that these charges are what is billed to the insurance companies or government payer, not necessarily what a patient will owe. Each insurance company has a negotiated rate that determines what they will pay for a procedure or hospital stay. For an employer-sponsored plan, the employer determines how much of that negotiated rate is the patient’s responsibility. Medicare and Medicaid rates are determined by those government agencies.

The best way for patients to determine an out-of-pocket cost is to get a procedure code from your physician and then contact the hospital for a price quote based on the patient’s coverage plan. Patients also should keep in mind that care provided by physicians is billed separately by that provider’s office.

Beginning Jan. 1, 2019, the U.S. Department of Health & Human Services and Centers for Medicare & Medicaid Services (CMS) require hospitals and health systems to post their “current, standard charges.”

Hospital charges refers to the amount a hospital bills an insurer for a service. For most patients, insurers reimburse hospitals well below what was charged.

Patients covered by commercial insurance products have negotiated rates with hospitals. Patients covered by Medicare or Medicaid programs have hospital reimbursement rates determined by federal and state governments.

Hospital charges may include bundled procedures, personnel, services and supplies. An example would be room rates that include the space, equipment, nursing personnel and supplies.

We intend to meet the new requirements set by CMS regarding the posting of negotiated prices. However, given the ongoing uncertainty surrounding enforcement of the requirements, we have determined that the best course of action is to await a final ruling in this matter. 

We understand that the American Hospital Association (AHA) is currently reviewing the federal Court of Appeals ruling against their legal challenge to the CMS final rule mandating that hospitals disclose their privately negotiated charges with commercial health insurers. The AHA is determining whether to appeal the case to the United States Supreme Court and has urged the incoming Biden administration to review the CMS rule. It is the AHA’s position that the disclosure of these rates will not help patients understand what they will actually pay for treatment and may actually cause greater confusion.

When a patient has the opportunity to shop for medical services, we encourage them to contact their insurer to understand the costs covered by their insurance company and what cost will be their responsibility. Prior to any procedure or service, Norton Healthcare offers patients the services of financial counselors to help them estimate their out-of-pocket expenses, dependent on the specific insurance information they provide. We also have multiple ways to financially assist patients, including helping them understand what resources are available and how to access those resources.

You can check our standard charges here.

Patients should contact Norton Healthcare directly for any further details.

For hospital procedure price quotes: Call (502) 272-5330.

You will be asked to provide the five-digit Current Procedural Terminology (CPT) code for the procedure you are asking about.