By clicking on the agreement below, I understand that the price of a hospital charge may not be the amount that an insurance company will pay or the amount I may owe for items or services that I receive at the hospital. The hospital’s standard list of charges (also known as the hospital’s “chargemaster”) is updated at least annually, but individual prices may change more frequently. Accordingly, some prices reflected in this standard chargemaster may not be the current price. I understand that any bill I receive from the hospital may include many different combinations of charges, which are dependent upon the services actually received as a patient at hospital, and, therefore, it is not possible to predict before all services are provided the actual charges or combination of charges that may be on an insurance claim or my hospital bill.
I also understand that the prices in the chargemaster are only hospital charges and do not include any charges incurred as a result of services provided by a physician or other licensed practitioner, regardless of whether such physician or other licensed practitioner is independent or employed by the health system.
I understand that a hospital charge represents the total cost to the hospital for a particular item or service. However, health insurers, including government payers like Medicare, typically pay less than the total cost of a hospital item or service based upon contracts that are entered between each insurer and the hospital. Your insurer determines the amount you owe after the insurer pays the hospital under the contract. . I also understand that, if I receive medically necessary services as a self-pay patient, I may be eligible to receive discounts on the prices listed in the chargemaster. Any such discount is based upon the hospital’s policy related to the same and my specific facts and circumstances.
For an estimate of the amount you may owe for hospital items or services, please contact one of our financial counselors at 270-706-6990 or toll free at 844-727-6990.