What the
hospitals do NOT want you to know!
Hospitals do not provide you with their
actual cost when the bill is delivered to you:
This website gives you the hospitals
average cost as a percentage of the
hospital's overall charges.
The hospital mark-up is different for
different services. But the hospital's
average cost per dollar billed is known. We
have published the information for you.
When you look at your hospital on this
website, click on "Total Charges" and
look to the upper-right and find:
Cost to Charge Ratio
It if says 0.33, that means the
hospital's actual cost is only .33 of what
they charge. In other words, 33¢
on the dollar charged.
Click here to
find the hospital(s) you would like
information on.
Hospitals do not want
you to know what Medicare pays for the same
condition:
Most hospitals will
tell you that Medicare pays too little
causing the hospital to lose money on
Medicare patients.
That is not true. The
law requires Medicare to pay on average 1%
more than cost at an efficient hospital.
What Medicare pays
should be a starting point in determining a
reasonable charge for you.
In the deal the
Minnesota Attorney General made with the
seven-hospital Fairview Health Services, the
hospitals would be required to charge
self-pay patients no more than 5% above
Medicare or Medicaid rates, whichever is
greater.
Generally Medicare
pays more than Medicaid.
If you follow the
guidelines set by the Minnesota Attorney
General, you would be paying your hospital
Medicare plus 5%.
The problem for you is to
know:
What does Medicare pay
for the same condition I had?
You need to get from
the hospital the Medicare DRG code (for
inpatient services) or HCPCS codes (for
outpatient services) for you treatment.
Your hospital should
be willing to provide you a UB-92 or UB-04 providing your Medicare
diagnostic/treatment codes. In
the lower right hand corner of the UB-92 or
UB-04 is
your DRG code. HCPCS codes are
listed next to "billable" treatments you
received on either a UB-92 or UB-04.
Get your DRG or HCPCS
codes,
register, and then you can fax your
UB-92, UB-04, CMS-1450, CMS-1500, or form 837 to (317)293-0603. We
may be able to
tell you what Medicare would pay for the
hospital treatment you received.
Once you are more
informed, you can better negotiate
with the hospital.
We believe in general
you should pay no more than Medicare plus
25%. That is a generous payment from you.
Minnesota has required hospitals accept
Medicare plus 5%. We suggest you offer
Medicare plus 25%.
Please feel free to
contact us!
