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It is important to note, a hospital "charge" is not the same as "expected payment." A charge is the amount billed for a service. In the vast majority of cases, hospitals are paid considerably less than the billed amount. Hospital charges are based on the type of care provided and can differ from patient to patient for the same service. The differences between patients are related to complications or varying treatments needed due to the patient's health.
Even though the hospital's prices on our list are the same for all patients, actual charges for each specific patient may vary from the listed standard charges due to a combination of factors.
Please read the important information below and then view our Price Guides for shoppable services, all items and services, and COVID-19 diagnostic tests.
CMS Pricing Transparency Rule Summary
The finalized rule from the Centers for Medicare and Medicaid Services (CMS) establishes requirements for hospitals operating in the U.S. to establish, update, and make public a list of their standard charges for the items and services they provide. These actions are necessary to promote price transparency in healthcare and public access to standard hospital charges. By disclosing hospital standard charges, CMS believes the public (including patients, employers, clinicians, and other third parties) will have the information necessary to make more informed decisions about their care. CMS believes the impact of these policies will help increase market competition and ultimately drive down the cost of healthcare services, making them more affordable for all patients. This final rule is effective on January 1, 2021.
In accordance with the regulation, South Texas Health System is required to make its list of standard charges for all items and services publicly available online in a machine-readable file, and provide a consumer-friendly display of at least 300 shoppable services.
A shoppable service is a service that can be scheduled by a healthcare consumer in advance. South Texas Health System must make public the standard charges for as many of the 70 CMS-specified shoppable services that are provided by the hospital, and as many additional hospital-selected shoppable services as is necessary for a combined total of at least 300 shoppable services. This list is provided to the consumer through a web-based Price Estimator.
- Healthcare consumers – at the time they use the tool – have the ability to obtain an estimate of the amount they will be obligated to pay the hospital for the shoppable service
- Self-pay and insurance estimates
- Real-time patient eligibility information
- Patients with their estimated out-of-pocket responsibility
Standard charges are the regular rate established by the hospital for an item or service provided to a specific group of paying patients. In compliance with the law, South Texas Health System makes available its standard charges in a machine-readable file including:
- The gross charge for an individual item or service that is reflected on a hospital’s chargemaster, absent any discounts
- The discounted cash price that applies to an individual who pays cash, or cash equivalent, for a hospital item or service
- The payer-specific negotiated charge a hospital has negotiated with a third-party payer for an item or service
- The de-identified minimum charge, which is the lowest charge a hospital has negotiated with all third-party payers for an item or service
- The de-identified maximum negotiated charge, which is the highest charge a hospital has negotiated with all third-party payers for an item or service
COVID-19 Diagnostic Tests
The Coronavirus Aid, Relief, and Economic Security Act (CARES) requires providers to make the cash price for COVID-19 diagnostic tests publicly available on its website.