In compliance with the Centers for Medicare and Medicaid Services (CMS) ruling that requires hospitals to publicly display a list of their standard charges online, Artesia General Hospital has provided a copy of its “Charge Master” for download.
The Artesia General Hospital Charge Master is a spreadsheet with more than 8,600 items and services that may be provided by Artesia General Hospital. Each line includes:
- Charge Code — A number that is assigned by the hospital and unique to an individual item or service
- Description — A description of the item or service
- Rate — The charge for each item or service
Please note that what the hospital charges for a service IS NOT the same as what you or your insurance company may pay for a service.
The rates provided in the Charge Master are a tool that healthcare providers use to negotiate contracts with insurance companies and evaluate the financial impact of these negotiations on the financial health of the institution. Charges are the same for all patients, but a patient’s responsibility may vary depending on payment plans negotiated with individual insurers. Further discounts are available for uninsured or underinsured patients who qualify.
More information is available in our FAQs below. Please note that healthcare billing is complex, and not every patient receives the same operating room time, procedures, medications or tests during his or her stay with us. If you have any questions on the cost of your procedure, please call us at 575.748.3333 and ask for our Billing department.
Frequently Asked Questions
How are charges set?
Charges are set by the hospital based on the total direct costs (professional fees, staffing, supplies, equipment, etc.) and indirect costs (administration, medical records, billing, housekeeping, maintenance, facility expenses, etc.) of providing the service. Often, charges are also compared to those established by other hospitals and clinics in the region to help ensure they are comparable.
Charges can sometimes be confusing because they reflect:
- The direct services the patient actually experiences
- All the things that happen behind-the-scenes that make those services possible
- The cost of making those services available every day throughout the year
What does Artesia General Hospital actually get paid?
Artesia General Hospital is rarely, if ever, paid the full amount of billed charges.
The hospital negotiates payment rates with every major insurance company that provides coverage to residents in our community. As part of that negotiation, the insurance company typically establishes an “allowable” rate for each item or service, and then further establishes a discount from that “allowable” rate that they will pay—minus any deductibles, coinsurance and co-pays that the insurance company indicates are the patient’s responsibility. This “allowable” rate typically falls well below hospital charges.
If an insurance company refuses to contract with the hospital, or the hospital is unable to negotiate a satisfactory contract with that insurance company, Artesia General Hospital may be considered “out-of-network” with that plan. The insurance company may then choose not to pay for the services received at an “out-of-network” hospital, increasing the patient’s out-of-pocket payments. It is likely that your insurance company has negotiated different payment rates with each hospital under contract.
What is the impact of charges on deductibles, coinsurance and copayments?
Deductibles vary by insurance company, from as little as $500 per year to $10,000 or more per year, and reflect the plan you or your employer selected and the premium paid for that coverage. The deductible is the amount you will pay each year before you receive full benefits from your insurance company. Lower-deductible plans typically have higher monthly premiums, while higher-deductible plans have lower monthly premiums.
Coinsurance is a percentage of the “allowable charge” that you will pay after you have reached your deductible, and is established by your insurance company and plan.
Copayments (or “copays”) are a flat fee you pay for a healthcare service, and are also established by your insurance company or plan. Copays can take effect either before or after your deductible has been met, and may not apply to all services.
Information about your deductibles, coinsurance and copayments are available from your insurance company or employer.
What about Medicaid?
Medicaid pays all hospitals based on the same fee schedule. You can view the fee schedule or lookup a Medicaid fee by going to the New Mexico Human Services Department website:
http://www.hsd.state.nm.us/providers/fee-schedules.aspx
What about Medicare?
As a federally designated Prospective Payment System Hospital (PPS), payment schedules vary depending on the services provided. If you have a supplemental plan or Medigap coverage, it will cover some or all of your deductible, coinsurance and copays. You will need a separate Medicare Part D plan to secure insurance coverage of drugs.
If you have enrolled in a “Medicare Advantage Plan,” you no longer have traditional Medicare. These plans are offered by private insurance companies and have different monthly premiums, deductibles, coinsurance and copays. Some of these plans will include drug coverage, but you cannot buy a Medigap policy.
Information about your deductibles, coinsurance and copayments are available from the insurance company that sold you the “Medicare Advantage Plan.”
What about patients who do not have insurance coverage?
For patients with no insurance, Artesia General Hospital provides an “uninsured discount,” which lessens the amount owed by the patient for services provided. The discount is based on how quickly the patient pays his or her account.
To determine if you qualify for financial assistance, please visit our Financial Assistance page or call us at 575.736.8199.
Questions
If you have questions about the Artesia General Hospital Charge Master, please call us at 575.748.3333 and ask for our Charge Master Coordinator, extension #2837.
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