We’re here to help you make informed
choices about your healthcare. This includes helping you know, beforehand, an
estimate (or “best guess”) of how much your care will cost you after your
insurance pays its part (or, if you don’t use insurance, how much you’ll be
charged in total).
We give estimates for a wide
range of common medical services by looking at how much these services usually
cost – based on what all they include and need. This estimate is our best
guess, at the time, for how much your service will cost too. But our
estimate may not match your final bill exactly. Your final bill will depend
on the actual services, drugs, supplies and procedures you get, based on the
decisions of the doctors who are caring for you.
Please keep in mind that there may be
separate costs –
in addition to your hospital costs. These may include charges from Arrow
Ambulance, Home Infusion, the medical supply company and other services. These
are different for each person, based on your unique situation in the hospital,
and they’ll not be included in your cost estimate.
It’s best to contact your insurance company to ask which services and goods they’ll
help pay for – and which things you yourself will need to pay for. They (rather
than the hospital or your doctors) know your specific health insurance plan, what
it covers and what costs you’ll have to pay for out of your own pocket. You
can usually find the phone number for your insurance company on your insurance
ID card. When you call them, be ready to tell them:
·
The
name (and a description) of the medical service you’re getting.
·
The
procedure code(s) of the medical service. You can get this code from
your doctor’s office.
“Hospital charges” are the costs a hospital bills for a
service. Patients with insurance often pay far less than the amount listed.
Our Patient Financial Services team can
give you estimates and help you understand costs. Call them Monday through Friday, 8
a.m. to 5 p.m., at (888) 71-CARLE or (888) 712-2753.
If you get your cost estimate and think it may cause you financial hardship, our Financial Assistance Program may be able to help you pay for some or all of your costs. To learn more about this program, click here.
First, before you start filling out
the form for your cost estimate, please have this information ready:
·
The
name of the medical service you’re getting (for example: chest X-ray, brain CT, etc.).
·
Your insurance
information (if you have insurance), including the company’s name, your member
ID/policy number and your group number. This information is usually on
your insurance ID card.
Your insurance information will help
us give you an estimate of how much you yourself will owe after your insurance company
pays its part. If
you choose not to give us this information, we’ll give you the estimated total costs,
and you’ll need to use the specifics of your insurance plan (its deductible,
copays/coinsurance, noncovered costs, etc.) to come up with an estimate of how
much you’ll pay out of your own pocket. Because this can be complicated,
however, we recommend you contact your insurance company for a more accurate estimate
if you don’t want to give us your insurance information.
The cost shown is an estimate based on
the information you give us. This estimate cannot and should not be relied on
as the actual or final charges and/or payments you’ll
be responsible for paying, and it’s in no way a
quote, guarantee or contract for the amount that you may
owe. You’ll be responsible for the actual amount you owe for services
rendered.
Patient First and Last Name
Please enter your
name exactly as it appears on your insurance ID card (if you have insurance).
Phone Number
The best phone
number to reach you.
Birth Date
We need your birth
date for your insurance to work.
Referring Physician Name
The doctor who
ordered your test or procedure. Enter the first and last name of your doctor.
For surgeries, please enter the surgeon's first and last name.
Referring Physician Phone Number
The doctor’s
office number.
Procedure Code Provided by Physician
Ask your doctor
for this. It’s a five-digit code (called a “CPT code”) for your specific
procedure/test. Enter the code if you have it.
Preferred Facility Type
The type of facility
where your procedure/test will take place.
Description of Procedure/Service
Correct spelling
is important – so ask your doctor to clearly print the name of your
procedure/test for you to have handy. Many procedures and tests sound familiar,
so make sure you put in the correct one. If you have more than one procedure/test,
enter them all, separated by commas.
Anticipated Date of Service
The day you
expect to have your procedure/test. If you don’t know the expected date, enter
a “best-guess” date (use the format mm/yyyy).
Health Insurance Company
Please enter your
insurance company’s name exactly as it’s shown on your insurance ID card (for
example, Aetna PPO).
Policy Holder’s Name
Please enter the policy
holder's name exactly as it’s shown on your insurance ID card.
Member ID/Policy #
Please enter the
Member ID/Policy # or Subscriber # exactly as it’s shown on your insurance ID
card. This might be numbers, letters or a combination of both.
Group #
Please enter the
Group # or Plan Name/Description exactly as it’s shown on your insurance ID
card. This might be numbers, letters or a combination of both.
Health
Insurance Company Phone
Please
enter the Customer Service or Provider phone number that’s listed on your
insurance ID card.
Copayment (Copay) and Coinsurance
The amount you
yourself owe, out of your own pocket, for a procedure, service, test, medicine,
etc. Your insurance pays the rest.
If this amount is a fixed dollar
amount – like $10 – it’s called a copayment (copay). If it’s a percentage
of the total cost of the service – for example, if you have to pay 10% of the
total cost and your insurance pays the rest – it’s called coinsurance.
Deductible
The amount you
yourself need to pay, out of your own pocket, for medical services before your
insurance kicks in – in other words, a set dollar amount you need to reach (in
total spending) before your insurance begins to help you pay for things.
For example, if your deductible is $1,000, you yourself will pay the full cost
of any medical services you have until your total spending for that year*
reaches $1,000 (note that only spending on services that are “covered” by your
insurance count). Once you spend $1,000, your insurance will start helping you
pay – and you’ll usually only need to pay your copayments/coinsurance amounts
for the rest of the year*, as long as your services are “covered” by your
insurance.
Note that your insurance company may
help you pay for some specific medical services even before you reach
your deductible amount – call your insurance company for more information.
Network
Your insurance
“network” is the group of specific doctors, hospitals, pharmacies and other
healthcare facilities your insurance company has partnered with to give you
care. Some insurance plans don’t let you see doctors (or visit hospitals,
etc.) that aren’t in your “network” (except for emergency care) – or you may
pay more for getting care at these “out-of-network” places.
Nonpreferred Provider
A doctor, hospital or other medical provider that’s not in your
insurance’s “network.” Some insurance plans don’t let you see doctors (or visit
hospitals, etc.) that aren’t in your “network” (except for emergency care) – or
you may pay more for getting care at these “nonpreferred”/“out-of-network”
places. Call your insurance company for more information about specific
doctors, hospitals and providers.
Out-of-Pocket Limit
When your total spending – that you yourself pay out of your own pocket – for
medical services “covered” by your insurance plan reaches the “out-of-pocket
limit,” your insurance will usually begin to pay 100% of the costs for any
additional “covered” services you need for the rest of the year*. The
“out-of-pocket limit” is also called the “out-of-pocket maximum.”
For example: If your “out-of-pocket
limit” is $5,000, once you’ve paid a total of $5,000 throughout the year* for
all your “covered” services, you’ll no longer need to pay any copayments or
coinsurance for the rest of your “covered” services that year*.
Note: You (or your employer) will
still need to pay your monthly premium (see definition below), even after
you’ve reached your “out-of-pocket limit.”
Premium
A regular cost
– often a monthly bill – that you or your employer pays for your insurance.
Sometimes premiums are paid quarterly or yearly, rather than monthly.
If you have any questions about any of
these terms – or about insurance in general – call your insurance company.
Their phone number can usually be found on your insurance ID card.
*Note: Most insurance plans (also
called “policies”) last for a year. However, some are different – and not all
have the same start and end dates. Call your insurance company to find out when
your plan’s “year” officially begins and ends.
“Transparent pricing” means costs
that are clear and easy to understand, as much as possible.
Since January 1, 2021, the U.S.
Department of Health & Human Services and the Centers for Medicare &
Medicaid Services have required hospitals and health systems to post their
"current, standard charges." You can download and view these files
here: