Patient Pricing FAQs

In an effort to assist those individuals who may be seeking healthcare services we think it is essential now more than ever to provide pricing information so that people can make informed decisions about their healthcare cost. This information allows consumers to better anticipate and understand their financial responsibilities as it relates to their medical care at our hospitals.

Providing this visibility is just another way we exhibit our vision and mission of providing excellent patient care.

What is Price Transparency?

"Price Transparency" is the term used to describe initiatives in the healthcare industry to provide meaningful pricing information to consumers. The healthcare industry is often complex and difficult for consumers to navigate. Price transparency is a means of providing consumers price information on common services.

What is a chargemaster?

A chargemaster is a comprehensive list of standard charges for each inpatient and outpatient service or item provided by a hospital – each test, exam, surgical procedure, room charge, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a chargemaster contains thousands of services and related charges.

Chargemaster amounts are almost never billed to a patient or received as payment by a hospital. The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted rates to the services that are billed. In situations where a patient does not have insurance, Emory Healthcare has financial assistance policies that may apply discounts to the amounts charged.

Is the charge the same as what the patient pays?

Chargemaster information is not particularly helpful for patients to estimate what their health care services are going to cost them. The charge listed in the chargemaster is generally not the amount a patient will pay. If you have health insurance, the amount you will be billed and expected to pay for your services depends on your specific health insurance coverage and your insurance company’s contract with the hospital. If you do not have health insurance, you may be eligible for reduced costs under Augusta University Healthcare’s financial assistance policy, or you may be eligible for Medicaid coverage.

How much will I have to pay out of pocket? 

Health plans and/or patients pay the hospital; however, the total amount is significantly less than the hospital charges. Your insurance provider may be the best resource to provide you with your financial obligation based on your specific health plan information. Generally, a patient with health insurance will pay a deducible, copayment, and/or coinsurance, as set by their health plan. Health insurance plans, including Medicare, Medicaid, commercial health plans, and worker’s compensation, do not pay charges. Instead, they pay a set price negotiated in advance. The patient then pays the out of pocket amount set by the health plan.

What do the following health care terms mean?

Deductible: Amount the patient must pay for services before the health plan begins to pay. The deductible may not apply to all services.

Copayment: Fixed amount, e.g., $20.00, the patient pays for covered health care services, like an office visit or prescription.

Coinsurance: Percentage the patient pays for covered health services, e.g., 20% of the total bill after insurance processes.

Can I get an exact pricing quote?

Unfortunately, no. We will do our best to provide you with a pricing range based on our hospital’s historical pricing for comparable services. The list of charges is the same for all patients. However, the total charges for an individual patient often vary from one patient to another for a number of reasons, including but not limited to:

  • How long it takes to perform the service or how long it takes you to recover in the hospital
  • Whether the service or procedure you receive is more or less difficult than expected
  • Whether you experience complications and need additional treatment
  • Other health conditions you may have that may affect your care

Also, our estimates are for the services provided at our hospitals and will not include physician’s services for treatment or interpretations of completed exams such as imaging or pathology. You may receive separate bills for these services.

When I call for a pricing estimate, what information do I need to have available?

Before you call, it is a good idea to contact your physician’s office to get the best description possible of the services you need. Then, if you have insurance, contact your insurance company and make sure the services required are “covered services” under your specific plan. If they are not “covered”, then you would be considered “uninsured” for these services.

When you call us, please try to have the following information at hand so that we can provide you with our best estimate of your financial responsibility:

  • Description of services needed – We will need to know as much information as possible about the specific services needed as described by your physician.
  • Type of services needed – We need to know if you will be admitted to the hospital as an inpatient overnight, or if you are expected to be treated on an outpatient basis.
  • Physician/Specialist Name – Example: if you are having surgery, we will want to know the surgeon’s name.

If you have insurance, we will also need:

  • Your insurance card – Please have your card available so that, if needed, we can get the following information from you: name of insurance company, type of policy (e.g. HMO, PPO, POS, Indemnity), policy holder’s name, group name and number, policy number, insurance company phone number.
  • Policy holder’s personal information – It is possible that the insurance company will want us to verify the Social Security Number and date of birth of the person who is named as the primary insurance policy holder.

What is expected of patients in terms of payment?

Similar to your visits to your physician’s office, we expect payment at time of service. If you have insurance or other coverage, we will expect you to pay your copayment, coinsurance and/or deductible upon arrival at the hospital.

We will submit your claim for medical insurance to your insurance for you. After your insurance company processes your claim we will send you a patient statement with information about any amount you may still owe.

If you are uninsured, we expect payment at time of service (or will work with you to arrange monthly payments) for the estimated price of your services. If, after your services are received, any additional payment is due, we will send you information about any amount you may still owe. If you receive care and cannot pay for your services, with your cooperation, our financial counselors will evaluate whether you qualify for Medicaid or our Patient Financial Assistance Program.

We accept major credit cards, checks, money orders and cash.