Patient and Visitor Information

Understanding Hospital Charges

Gathering information regarding the "charge" amount or potential out of pocket liability are key factors in the decision on where to seek healthcare services. The amount a facility bills for a patient's care is known as the "charge." This is not the same as the actual cost, expected payment, or amount paid for the care. In most cases, Hospital charges do not provide customized information about what you will pay for your healthcare services. Hospitals are typically paid less than the billed charged amount. Factors other than the charge or price, such as quality of care, should also be considered when choosing a healthcare provider. View information regarding quality and safety at Hospital for Special Surgery.

The following are common examples of why hospitals do not receive billed charges:

  • Government programs such as Medicare, Medicaid, Workman's Compensation, and No-Fault pay healthcare providers based upon a standard calculation which is typically much less than the billed charge. Hospitals have no ability to negotiate reimbursement rates for these government-paid services.
  • Commercial insurers or other purchasers of health care services usually have pre negotiated discounts in place with hospitals on behalf of the patients they represent.
  • Hospitals have financial assistance policies that offer the uninsured or low-income persons discounted charges based upon household income and ability to pay.

Estimates for an upcoming hospital service can be obtained by contacting the Hospital for Special Surgery Insurance Advisory Service at 212.774.2607 or by email through our online form.  If you would like to view a list of our charges, you can visit the Hospital and an associate will provide you with access and be available to answer any questions that you may have.  Please contact the Corporate Compliance and Internal Audit Department at 212.774.2070 to schedule an appointment.