Flushing Hospital Medical Center is committed to price transparency. To make it easier, we’ve provided helpful information here that can offer some insight on what you might expect to pay for certain healthcare services, in accordance with the Hospital Price Transparency Final Rule.
Our estimation tool provides standard charges for shoppable services available at Flushing Hospital Medical Center. As always, please remember that this is a planning tool. Final charges (the amount paid by your insurance and by you) can and will change based on a number of factors, including:
- Insurance coverage
- Insurance deductible
- Insurance copay
- Actual services and care provided
A financial counselor can help explain these and other factors that will impact your final charges.
About the Hospital Price Transparency Final Rule
All hospitals are required by federal law to provide standard pricing of shoppable services under the Hospital Price Transparency Final Rule. This rule is intended to help consumers gain a better understanding of what charges they may expect for their care. A shoppable service is a service that can be scheduled in advance. As defined by the federal government, shoppable services are those that are routinely provided in nonurgent situations that do not require immediate action or attention to the patient, thus allowing the patient to price shop and schedule a service at a time that is convenient for them. To obtain an estimate on one of the CMS 300 shoppable services (updated 1/4/24), click the Price Estimate Tool here: Healthcare terminology can be confusing, especially when you’re navigating insurance codes and billing information. Here are a few definitions you may have questions about:
- Standard charge: This is the standard price of items and services available through the hospital. Please keep in mind that the final cost of services and care will vary based on many factors.
- Charge: This is the final amount billed to your insurance for an item or service
- Chargemaster: The chargemaster is the large file that includes the list of standard charges for all services and items
Under the rule, definitions were established for the four types of standard charges your hospital is required to provide in a consumer-friendly display. These include:
- Discounted cash price: The charge applied to an individual who pays cash (or cash equivalent) for a specific item or service
- Payer-specific negotiated charge: The charge a hospital has negotiated with a third-party payer (such as an insurance company) for a specific item or service
- De-identified minimum negotiated charge: The lowest charge a hospital has negotiated with all third-party payers for an item or service
- De-identified maximum negotiated charge: The highest charge that a hospital has negotiated with all third-party payers for an item or service
Standard charges shown in the attached file do not necessarily reflect what a patient may pay. Government insurance plans such as Medicare and Medicaid do not pay the chargemaster rates, but rather have their own set rates which hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with managed care payors and may or may not reflect the standard charges. Patients without commercial insurance or not covered by a government health care plan should contact the hospital prior to a procedure to discuss charges, alternative pricing, and payment terms.
Professional fees, such as physician, radiologist, anesthesiologist and pathologist may not be all inclusive in this estimate.