Below is a Q & A based on billing questions we hear most often from our patients.
For insured patients, 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.
This negotiation is with each insurer at each healthcare organization.
The patient only pays the out-of-pocket amounts set by his/her health
plan. Therefore, 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-of-network," meaning the health plan does not have a contract with them. Contact your
insurance company to understand what your financial obligations will be.
Learn more about our new service offering
Up-Front Cost Estimates.
If you need help understanding your health care bill, please contact the
Hospital’s Billing Department at 217-466-4517.
A patient without health insurance can discuss discounted healthcare with our Financial Assistance Coordinator. Call (217) 466-4257 or visit Financial Assistance.
Deductible
The amount the patient needs to pay for health care services before the health plan begins to pay. The deductible may not apply to all services.
Copay
A fixed amount (for example, $20) the patient pays for a covered health care service, such as a physician office visit or prescription.
Coinsurance
The percentage the patient pays for a covered health service (for example, 20% of the bill). This is based on the allowed amount for the service. You pay coinsurance plus any deductibles you owe.
Healthcare plan coverage
This includes the deductible, copay, and coinsurance and 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 (i.e., in-network, out of network, consulting physician, etc.). Patients need to contact their health plan for this specific information.
Total Charge
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 treatments provided due to the patient's health. Click here to see our list of charges.
Cost
A hospital's cost of services can vary depending on additional factors, such as:
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. Medicare pays hospitals much less than the hospital charge and typically less than their total costs. Medicaid reimbursement is even lower and significantly below actual cost.
Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges.
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.
Visit our Billing & Insurance page for more information on price estimates.
Visit our Charges page for a detailed list of charges.
Learn more about Up-Front Cost Estimates.