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What is a Chargemaster?
A chargemaster is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital – each test, exam, surgical procedure, room charge, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a chargemaster contains thousands of services and related charges.
Chargemaster amounts are almost never billed to a patient or received as payment by a hospital. The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted rates to the services that are billed. In situations where a patient does not have insurance, our hospital has financial assistance policies that apply discounts to the amounts charged.
Financial & Charity Care Policies
Health insurance companies contract with hospitals to care for their customers. Hospitals are paid the insurance company’s contract rate, which generally is significantly less than the amount listed on the chargemaster. The insurance company’s contract rate, not the chargemaster, is the basis for determining the patient’s actual out-of-pocket costs. As an example, a hospital may charge $1,000 for a particular service, while the insurer’s contract rate may be $700. If the patient’s insurance plan indicates the patient is responsible for 20 percent of the contract rate, the patient would owe $140 (20 percent of $700), after any deductibles are met.
Are Charges the Same for Every Patient?
The list of charges is the same for all patients. However, the total charges for an individual patient often vary from one patient to another for a number of reasons, including:
What is Not Included in the Chargemaster list?
The hospital’s chargemaster does not include charges for services provided by the doctor (or 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.
Here is a partial list of health care providers who may bill you separately:
Can the Chargemaster Help Me Estimate My Out-of-Pocket Costs?
Chargemaster information is not particularly helpful for patients to estimate what health care services are going to cost them out of their own pocket. If you have health insurance, the amount you will be billed and expected to pay for your services depends on your specific health insurance coverage and your insurance company’s contract with the hospital.
To receive an estimate of charges for future service, call 919-350-7808 or fill out this form. Listen carefully to the menu options and choose the one that best meets your needs. Please keep in mind that this is only an estimate. Actual charges may vary depending on the treatment your physician orders for you.
If you do not have health insurance, you may be eligible for reduced costs under our financial assistance policy, or you may be eligible for Medicaid coverage.
Where Can I Find More Information?
If you would like more information about the chargemaster, what your care will cost you or our financial assistance policy, please contact Patient Financial Services by filling out this form or calling 919-350-7808.
Please consult with your insurance provider 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.
3000 New Bern Ave.
Raleigh, NC 27610