Standard Charges / Price Transparency

A hospital’s standard charges document is a comprehensive list of all the billable services and items provided by a hospital. Our standard charges capture the costs of each procedure, service, supply, prescription drug, and diagnostic test provided at the hospital, as well as any fees associated with services, such as equipment fees and room charges. It also includes payer-specific negotiated charges. Because hospitals operate 24 hours a day, seven days a week, standard charges can contain thousands of services and related charges.

Standard charges are almost never billed to a patient or received as payment by a hospital. These are the rates negotiated with insurance companies, Medicare, or MassHealth. These payers then apply their reimbursement terms or contracted rates to the services that are billed. If a patient co-payment, co-insurance, or deductible is owed, these too are most often not based on standard charges amounts but rather the payment terms determined by the insurer or government program.

Standard Charges: As required by the federal government (Centers for Medicare and Medicaid Services), we publish information (a comprehensive machine-readable file) about the rates negotiated with insurance companies for all services and items offered by our hospital. This file is listed below and available for download.

Shoppable Services: The Centers for Medicare and Medicaid Services Price Transparency rule requires that hospitals provide cost information on 300 "shoppable" items per hospital. This file is listed below and available for download.

WHERE CAN I FIND MORE INFORMATION ABOUT HOSPITAL COSTS?

We are committed to helping patients understand their costs when receiving care at Emerson. The best way to learn about the pricing of care is to reach out directly to us and your insurance carrier. If you would like more information about what your care might cost you or for details on Emerson Hospital’s financial assistance policy, please contact our Financial Services office at 978-287-3432 between 8 a.m. and 5 p.m., Monday through Friday.

Your health plan can also help you to understand your insurance coverage, which charges will be covered, how much you will be billed, information on deductibles, and your expected out-of-pocket responsibility.

FINANCIAL ASSISTANCE PROGRAMS

In situations where a patient does not have insurance, patients may be eligible for free or reduced cost of health care services through various state public assistance programs as well as the hospital financial assistance programs (including but not limited to MassHealth, the premium assistance payment program operated by the Health Connector, the Children’s Medical Security Program, the Health Safety Net, and Medical Hardship). Such programs are intended to assist low-income patients taking into account each individual’s ability to contribute to the cost of his or her care.

For those individuals that are uninsured or underinsured, the hospital will, when requested, help them with applying for either coverage through public assistance programs or hospital financial assistance programs that may cover all or some of their unpaid hospital bills. You can find more information on our financial assistance policies page or speak to a financial counselor in our Financial Services office at 978-287-3432 between 8 a.m. and 5 p.m., Monday through Friday.

WHAT IS NOT INCLUDED IN THE STANDARD CHARGES LIST?

The hospital’s standard charges may not include prices for services provided by the doctors who treat you while you are at the hospital. You may receive separate bills from the hospital and the doctors involved in your care.

The following provides a list of providers who may send a separate bill for any services provided in the hospital:

  • Your personal doctor, if he/she sees you in the hospital
  • The surgeon who performs your procedure
  • The anesthesiologist who works with the surgeon
  • The radiologist who reads your x-rays or other imaging
  • Other doctors who may be consulted by your doctor during your time in the hospital

ARE CHARGES THE SAME FOR EVERY PATIENT?

The list of charges is the same for all patients. However, methodologies for hospital reimbursement are extremely technical, with a multitude of factors that go into the amount health plans pay to providers for any given service. The total charges for an individual patient often vary from one patient to another for a number of reasons, including but not limited to:

  • How long it takes to perform the service or how long it takes you to recover in the hospital
  • Whether the service or procedure you receive is more or less difficult than expected
  • What kinds of medication you require
  • Whether you experience complications and need additional treatment
  • Other health conditions you may have that may affect your care

In some cases, an insurer may have multiple products with different prices for the same service. It is therefore likely that you will see different prices for the same service, depending on which insurer you are looking at.

As mentioned above, standard charges almost never reflect your out-of-pocket costs for treatment. Those costs will depend on the exact policy you are enrolled in and how it applies to the specific care service you are seeking. This listing also does not account for any financial assistance you may qualify for, nor will it be accurate if you are uninsured or seeking treatment that is not covered by your insurance policy.

MASSACHUSETTS TRANSPARENCY WEBSITE

Through the Center for Health Information Analysis (CHIA), the state has created a website, CompareCare (www.masscomparecare.gov), for consumers to compare costs of medical procedures across the Commonwealth. CompareCare also includes quality metrics where available. Regarding the cost quotes, the CHIA website provides an estimate based on amounts paid to health care providers in previous years. To find out what your specific out of pocket costs will be, contact your health plan.