Perry Memorial Hospital is committed to quality, convenient care, and service that meets each individual patient's needs. As a result, the hospital's standard charges for common procedures are publicly displayed for awareness. The Requirement for Transparency of Hospital Charges Rule in the Affordable Care Act requires all hospitals to establish, update, and make public their standard charges for items and services provided by the hospital.
The Requirement for Transparency of Hospital Charges Rule is intended to ensure patients understand the fees associated with hospital services and their own potential financial liability, in addition to allowing more convenient comparison of services across hospitals. However, hospital charge masters are lengthy documents, easily misinterpreted. Instead, Perry Memorial Hospital recommends that patients communicate with the Business Office regarding specific services to gain a detailed and accurate understanding of all associated financial liabilities. The Business Office can be reached by calling 815-876-3080.
The Healthcare Financial Management Association (HFMA) developed "A Guide for Consumers" to help patients understand what to expect from their medical bill, titled "Avoiding Surprises in Your Medical Bill." A copy of this guide is available to download:
Hospital charges are the amounts set before any discounts. Hospitals are required by the federal government to utilize uniform charges as the starting point for all bills. Charges are based on what type of care was provided and can differ from patient to patient for the same service depending on any complications or different treatment provided due to the patient's health.
These charges represent the standard charges for procedures and diagnostic testing. Actual charges may be different for specific patients due to medical condition, length of time spent in surgery or recovery, necessary specific equipment, supplies or medication, complications requiring unanticipated procedures or other treatment ordered by the physician.
A patient with health insurance needs to pay the deductible, copay, and/or coinsurance set by their health plan. Health plans such as Medicare, Medicaid, workers’ compensation, commercial health insurance, etc., do not pay charges. Instead, they pay a set price that has been predetermined or negotiated in advance. The patient only pays the out-of-pocket amounts set by the health plan. The financial obligations could differ depending on whether the hospital or physicians are "out-of-network," meaning the health plan does not have a contract with them. Contact your insurance company to understand what your financial obligation will be. A list of healthcare plans contracted with Perry Memorial Hospital can be found at www.perrymemorial.org.
A patient without health insurance will discuss financial assistance options available that could include either a complete write-off or a substantial reduction of the charges in accordance with the Illinois Hospital Uninsured Patient Discount Act and the hospital's financial assistance program. If you have questions about Perry Memorial Hospital’s Financial Assistance or any other offers of assistance, please call our Business Office at 815-876-2067 or 815-876-4431.
Deductible means the amount the patient needs to pay for healthcare services before the health plan begins to pay. The deductible may not apply to all services.
Copay means a fixed amount (e.g., $20) the patient pays for a covered healthcare service, such as a physician office visit or prescription.
Coinsurance means the percentage the patient pays for a covered health service (e.g., 20% of the bill). This is based on the allowed amount for the service. You pay coinsurance plus any deductibles you owe.
A patient’s specific healthcare plan coverage, including the deductible, copay and coinsurance, varies depending on what plan the patient has. Health plans also have differing networks of hospitals, physicians and other providers that the plan has contracted with. Patients need to contact their health plan for this specific information. A list of healthcare plans contracted with Perry Memorial Hospital can be found at www.perrymemorial.org.
Total charge is the amount set before any discounts. Hospitals are required by the federal government to utilize uniform charges as the starting point for all bills.
The charges are based on what type of care was provided and can differ from patient to patient for similar services, depending on any complications or different treatment provided due to the patient’s health.
Cost is the total expense incurred to provide the healthcare. Hospitals have higher costs to provide care than freestanding or retail providers, even for the same type of service. This is because a hospital is open 24 hours a day, 7 days a week and needs to have everything necessary available to cover any and all emergencies. Non-hospital healthcare providers can choose when to be available and typically would not provide services that would result in losses. A hospital’s cost of services can vary depending on additional factors such as:
Total Reimbursement is the amount actually paid to a hospital. Hospitals are paid by health plans and/or patients, but the total amount paid is significantly less than the starting charges.
Patients may also qualify for discounted services based on household income as compared to the Federal Poverty Level. Please visit the Financial Assistance page at www.perrymemorial.org to find out more and learn about steps to apply for financial assistance.
Charge information is not necessarily useful for consumers who are “comparison shopping” between hospitals because the descriptions for a particular service could vary from hospital to hospital and what is included in that description. It is difficult to try to independently compare the charges for a procedure at one facility versus another. An actual procedure is comprised of numerous components from several different departments — room and board, laboratory, other diagnostics, pharmaceuticals, therapies, etc.
A patient who has the specific insurance codes for services requested, available from their physician, can better gauge charge estimates across hospitals. Ask your physician to provide the technical name of the procedure that has been recommended as well as the specific ICD and CPT codes for service.
If you need an estimate for a specific procedure or operation, please contact Perry's Business Office at 815-876-3080.
Such an estimate will be an average charge for the procedure without complications. A physician or physicians make the determination regarding specific care needed based on considerations using the patient’s diagnosis, general health condition and many other factors. For example, one individual may require only a one-day hospital stay for a particular procedure, while another may require a two-day stay for the same procedure due to underlying medical condition.
Remember, patients with health insurance will only pay the specified deductible, copay and coinsurance amounts established by their health plan. Patients without health insurance or sufficient financial resources may be eligible for significant discounts from charges. Please contact the patient financial services office for further information.