How are prices established for services?
Each hospital has its own policy for setting prices. Hospital charges vary because they reflect the individual hospital’s mission and the Patient population it serves. Prices are reviewed each year on January 1, and are subject to change during the year. To establish prices, many factors are considered including:
- The cost of staff, equipment, medications and other supplies involved in Patient care
- The amount of time facilities and staff are involved in providing services
- The cost of administrative expenses such as billing, technology, housekeeping, etc.
- Insurance company contracts
- Information provided by the Centers for Medicare and Medicaid Services, the federal agency that manages the Medicare and Medicaid programs
Do these prices reflect the total cost?
Not necessarily. In addition to your hospital charges, you could receive separate bills for physician’s fees from your surgeon, anesthesiologist, radiologist, emergency room physician and other specialists.
What is a CPT code?
CPT stands for Current Procedural Terminology. A CPT code is a five-digit code used by all hospitals, physicians and insurance companies to identify a type of service or procedure. You will see CPT codes located on pricing lists to help ensure you are viewing the price information for the specific procedure your physician has ordered.
What is a DRG?
DRG stands for Diagnosis Related Group. A DRG is only assigned to an inpatient hospital service. DRGs are universal groupings used by Medicare and most insurance companies to clarify the type of inpatient care a Patient receives. Insurance companies use the DRG code, along with a diagnosis/CPT code and the length of the inpatient stay, to determine payment and reimbursement for claims.
Will my bill be different than the price listed on your website?
The amount you owe may vary due to a number of circumstances:
- Additional testing, medications, services or procedures ordered by your physician
- The procedure planned may not be the procedure performed based on your physician’s assessment
- If you have insurance, the type of insurance you have, your deductibles, coinsurance, and out-of-pocket limits will determine your Sparrow Eaton Hospital bill.
If I have insurance, does this reflect how much I will have to pay?
No. The amount you will be responsible for will depend on your specific insurance plan. We have provided an average of the reimbursement Sparrow Eaton Hospital receives from insurance companies for these procedures, but our customer service representative can assist you in determining an individual estimate of your out-of-pocket costs based on your personal insurance policy. That person can be reached at (517) 543-1050, ext. 52740.
If Sparrow Eaton Hospital is out-of-network, may I still receive care there?
Yes. In an emergency, always go to the closest hospital. Your insurance provider generally will cover emergency department costs or recommend a transfer to an “in-network” hospital when it is safe to do so. If you choose to go to an “out-of-network” hospital in a non-emergency, you may be required to pay a larger deductible or a greater portion of your bill. Call your insurance company to find out your health plan’s “out-of-network” options.
How will I know how much I owe?
Your health plan may require a copayment or deductible that will be due during appointment registration. Check with your insurance provider on the amount you will be responsible for at this time. Following your healthcare services, your insurance provider will send you an Explanation of Benefits (EOB), which will detail the amount it has paid, any non-covered or denied amounts, and the remaining balance that you are responsible for paying. Review this EOB, compare it to your Sparrow Eaton Hospital billing statement, and call your insurance provider or an Sparrow Eaton Hospital Financial Assistance Specialist if you have questions or concerns.
Can I receive an estimate for the cost of a procedure before I receive the service?
Yes. We can help you determine the cost of a medical procedure or service. Contact Sparrow Eaton Hospital Financial Assistance Services at (517) 543-1050, ext. 52740 to speak to a specialist. Before you call, please be sure to have your health insurance card, the name of your primary care provider, and information about the procedure you will be having.
Is there help if my health insurance does not cover my bills?
Yes. Sparrow Eaton Hospital Financial Assistance Specialists help individuals and families who have health insurance but need additional financial resources to cover medical bills. We can identify and help you apply for programs including Medicaid, Social Security, and other financial assistance.