Policy
It is the policy of Iroquois Memorial Hospital to allow the public access to Iroquois Memorial Hospital's standard charges for services obtained.
Purpose
The purpose of this policy is to ensure timely and accurate responses to patient requests for the list of standard charges for services rendered by Iroquois Memorial Hospital, consistent with
business needs and applicable law.
Definitions
As used in this policy:
A. Actual charge - means the amount charged to a specific patient, based on the type of care provided, which may vary from patient to patient, depending on complications and differences in
treatment provided due to a specific patient's health.
B. Iroquois Memorial Hospital standard charge - means the standard charge for diagnosis-related groups and the uniform amounts set before any discounts and used as the starting point for all
bills, as required by the federal government. A standard charge is the charge for care without complications.
Procedure
A. General Information
1. Actual charges are based on the type of care provided to a specific patient. Therefore, actual charges will differ from Iroquois Memorial Hospital standard charges.
2. 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 practitioner.
3. Iroquois Memorial Hospital charges are separate and distinct from practitioners' charges. In certain instances, practitioners, who furnish services to patients during their admission may
be independent contractors who are not agents or employees of Iroquois Memorial Hospital. Patients should be informed that emergency room physicians, radiologists, pathologists, etc., who
render professional services, bill and collect independently for their services. Patients understand that a practitioner's charges and/or bill will be separate and apart from the Iroquois
Memorial Hospital billing and collections, even if the hospital bills on the practitioner's behalf.
B. Estimates/Financial Assistance
The public may obtain Iroquois Memorial Hospital standard charges by calling 815.432.7706 Monday through Friday from 8:00am-4:30pm. Designated
representatives from Patient Financial Services will be available during these hours to assist the public with accessing the information. The information will be made available verbally in
person, by phone, or in writing if requested.
Iroquois Memorial Hospital is committed to being transparent about our charges.
The information provided below contains a comprehensive listing of our charges for services provided by the hospital, also known as our charge master. These prices are effective as of January
1, 2024 and are subject to change. Price updates throughout the year will not be reflected in the summary and detailed charge listings below. For room & board charges and price ranges for
common procedures, please refer to the summary of common charges link provided on our website. The charge master listing below is not a helpful tool for patients to comparison shop
between hospitals or to estimate what health care services are going to cost them out of their own pocket. Your own charges and out-of-pocket expenses will depend on the actual patient care
services you receive, the terms of your insurance coverage, and/or your eligibility for financial assistance.
In determining your individual expenses for upcoming services, we recommend that you please contact our Business Office at 815.432.7706 to request an
individualized estimate or use the link below to access our online estimation tool. Please understand that patient estimates are not a guarantee of actual charges. The price estimate is only
for the quoted procedure known prior to service and may not include items such as separate physician fees, additional tests or procedures not on the price quote, or for procedures your doctor
might add while you are having services performed. Our Business Office will also be able to assist you with information regarding payment arrangements and/or financial assistance eligibility.
Independent practitioners providing services at Iroquois Memorial Hospital including but not limited to, surgeons, radiologists, pathologists, anesthesiologist and specialty clinic
practitioners, bill for their services separately and are responsible for their own participation agreements. Independent practitioners may not be participating providers in the same networks
as the hospital. If you will be receiving services from an independent practitioner, we strongly encourage you to contact your insurer for participating provider information. New
practitioners to Iroquois Memorial Hospital may also not be considered participating practitioners until they are approved by each individual insurer's credentialing department. Furthermore,
when new agreements are added, physicians may not be approved as participating at the same time as the agreement effective date. If you are seeing a new practitioner please contact your
health plan to inquire as to the practitioner's participating status.
A Summary of Common Charges is provided for your convenience here.
The Centers for Medicare & Medicaid Services (CMS) has issued a final rule that requires hospitals to post their standard charges effective January 1, 2019 in a machine readable format on
the internet and update it at least annually.
A detailed listing of charges is provided here.
The nationally based Healthcare Financial Management Association (HFMA) developed an aid to assist patients with better understanding of hospital charges. A copy of this guide is herein
provided:
Illinois hospitals are committed to and working on improving price transparency that will provide the most meaningful and useful information for patients and consumers. It is important to
note:
- Federal law requires hospitals set uniform charges (the amount set before any discount) as the starting point for all bills.
- The starting list of charges is the same for every patient, but the charges may vary by patient even though a similar procedure was performed. This may be due to the patient's medical
condition, length of time spent in surgery or recovery, complications requiring unanticipated procedures, kinds of medication needed, etc.
- Illinois hospitals are not paid these charges by patients or health plans.
What does the health plan pay?
- Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges. Medicare and
Medicaid pay according to a regulated fee schedule - both pay at much less than what it costs the hospital to provide the service.
- Medicare and Medicaid pay hospitals based on pre-set rates that can vary among individual hospitals because they may reflect the variation in a hospital's cost to provide that care, such
as trauma, teaching programs, severity of illness and area wages among other things.
- On average, Medicare pays Illinois hospitals only about 90% of what it costs hospitals to provide the care and Medicaid payment is much less.
So How Much Will a Patient Pay?
- Although all bills start with charges, patients without health coverage are protected by Illinois' groundbreaking legislation, the Hospital Uninsured Patient Discount Act. It causes bills
to eligible uninsured patients be either completely written off (free) or have significant discounts applied (bill reduced to 135% of the hospital's cost). In addition, there is a maximum
collectible of 25% of annual family income. Please see additional information on the Iroquois Memorial Hospital website for details about applying for this patient financial assistance or
contact our Business Office at 815.432.7706.
- Patients with health coverage will only pay the deductible, coinsurance or copay required by their health plan. Although hospitals can assist with estimated charge information for the
service being sought, the health plan is the best source of information pertaining to what an insured patient will pay.
How Much Will I Actually Have To Pay Out Of My Pocket?
Patient pays:
- A patient with health insurance needs to pay the deductible, copay and/or coinsurance set by their health plan.
- The financial obligations could differ depending on whether the hospital or physicians are "out-ofnetwork," meaning the health plan does not have a contract with them. Contact your
insurance company to understand what your financial obligations will be.
- 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.
- Please see additional information on the Iroquois Memorial Hospital website for details about applying for patient financial assistance or contact our Business Office at 815.432.7706.
Health insurance plan pays:
- 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.
What Do the Following Health Insurance Terms Mean?
- 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.
What is the Difference Between Charges, Cost and Price?
- 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: For a hospital, it 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:
- Types of services it provides since many vital services are provided at a loss;
- Providing medical education programs to train physicians, nurses and other healthcare professionals, again provided at a loss;
- More patients with significantly higher levels of illness, yet payment doesn't cover;
- A disproportionately high number of patients who are on public assistance or uninsured and unable to pay much, if anything, toward the cost of their care.
- Total Price 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.
- On average in 2017 Medicare paid Illinois hospitals only 90% of a hospital's cost to provide that care and Medicaid pays even less.
- Medicare and Medicaid pay hospitals according to a set fee schedule depending on the service provided, much less than the hospital's total charge and actually less than their costs.
- Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges.
How Can I Use This Hospital Charge Information To Compare Prices?
- 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.
Important Contact Numbers For Iroquois Memorial Hospital Billing and Financial Assistance:
Business Office: 815.432.7706
Quality Care:
An important component for choosing a health care provider is determining quality of care. Your doctor can be a helpful resource in choosing where to obtain care. Further Medicare
hospital-specific quality outcome measures are located on the Hospital Compare website at www.medicare.gov/hospitalcompare.
To compare hospital median charges for nearly 50 major diagnoses, quality and patient satisfaction metrics in Illinois, go to the Illinois Hospital Report Card website at www.healthcarereportcard.illinois.gov.
