At Gateway Regional Medical Center, our goal is to provide patients with high quality care and the best possible hospital experience. We know that the billing and payment process may seem overwhelming at times and we want to be as helpful as possible.
To make the process more transparent, we are happy to follow CMS (Centers for Medicaid and Medicare Services) guidelines that require all hospitals to make available a list of standard charges (sometimes called a Chargemaster List) for products and services provided at the facility.
Before reading the list, please note that:
- The Chargemaster List does not generally reflect what a patient or insurer pays and not what the hospital receives in payment.
- In 2018 Gateway Regional Medical Center was paid, on average, less than 50 percent of charges.
- The charges included in the Chargemaster List do not reflect any discounts negotiated by insurance providers or other payment discounts that can greatly reduce the prices.
- What a patient will actually pay (or a patient’s responsibility) may vary depending on his/her individual health insurance plan, deductible amounts and co-pays.
Uninsured or under-insured patients should always consult with our staff to determine if they qualify for discounts. Please contact Customer Service (toll-free) at 877-349-0027 for assistance.
The prices included in the price list are correct as of November 30, 2018.
What is a charge?
A hospital charge is a federally-required maximum “list price” for an item or service that does not reflect any negotiated discount by the insurance provider. Hospitals are required to maintain a catalog of procedures, descriptions and list prices in a complex accounting tool, known as the hospital Chargemaster.
What do health insurance providers pay?
Insurers (including Medicare, Medicaid, commercial health insurance providers, and others) do not pay the charges listed in the Chargemaster List. Instead, they pay a set price that is negotiated in advance. Every insurance company pays the hospital differently based on their contract. Patients pay only the out-of-pocket amounts set by their insurance providers.
How can I use this hospital charge information for comparing prices?
Charge information, by itself, isn't generally useful to determine how much patients may need to pay, or to compare what a patient might owe a hospital. Discounts and fee schedules are used to determine how much insurance providers pay and may vary from hospital to hospital.
How are charges different from what insurance companies pay?
Again, Medicare, Medicaid and commercial insurance providers negotiate set prices for what they will pay for medical services. In most cases, what your insurance company sets as the reimbursement will be less than the hospital Chargemaster. For example, the charge for staying in a hospital room for one day may be listed in the Chargemaster as $1,500, but the negotiated fee agreed upon by the insurance provider may only be $700.
How are charges different from your possible out of pocket costs, like your deductible or co-insurance?
Deductibles and co-pay amounts are based on the reimbursement terms set by your insurance provider for covered services. They are rarely ever based on the actual hospital Chargemaster.
How can you receive a clearer customized estimate of your actual out of pocket costs?
For more information about your potential out-of-pocket costs, please contact your insurance provider prior to receiving care. Please contact our Business Office at 618-798-3750 to discuss any specific questions or to speak with a counselor about payment options.
Download a CSV file of
the average price procedure report that includes DRGs, Average Charge
per case and Average Medicare payment per case (total payment from both
medicare and the patient).
Download the Chargemaster List in CSV format for services at Gateway Regional Medical Center.
(In compliance with CMS guidelines, we are offering our Chargemaster List in a .CSV
format which is "machine-readable." It's also readable by people -- the
easiest way to do that is to download the file and open it using a
spreadsheet program, such as
Microsoft Excel, OpenOffice Calc, or Google Sheets.)