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Understanding Hospital and Physician Charges

Deciding where to receive care

When choosing a healthcare provider, many of us ask two questions:

  1. Will I get the best care?
  2. How much will it cost?

To answer the first question, HSS encourages patients to consider the provider’s reputation and rankings as well as evaluate the quality of care provided through publicly available data.

For the second question, HSS offers an Insurance Advisory Service, which provides personalized estimates based on insurance coverage. The Advisory Service will liaison between you, your insurance carrier, and the Hospital in order to provide information regarding your potential out-of-pocket costs for copayments, deductibles and coinsurance amounts.

HSS Insurance Advisory Service
212.774.2607 or complete our online form

Learn the difference between hospital charges and your actual costs

Beginning January 1, 2019, hospitals in the United States are required to publish a list of their standard charges. Each item and service the hospital provides has an associated listed "charge." The requirement is meant to be a first step in empowering patients to compare hospitals. 

Patients should be aware, however, that the charge amount may not be useful in predicting their actual cost of care. Other factors, like insurance coverage and income level are often more relevant than the charge amount. In most cases, the listed hospital charges for individual healthcare services will be different than the amount you will actually pay for those services. For an estimate of your out-of-pocket cost, please call the HSS Insurance Advisory Service. In addition, uninsured or low-income persons may apply for financial assistance.

A listing of HSS standard charges is available. Additionally, average charges for HSS inpatient care is available and presented by “DRG”, a system that groups inpatient care into major categories. If you have any questions about these listing of charges, please contact the Corporate Compliance and Internal Audit Department at 212.774.2070.

Physician charges – Separate from hospital charges

The physician services you receive at HSS are not included in the hospital's charges and will be billed separately. Physicians also make their own decisions regarding their participation in insurance plans and may or may not participate in the same plans as the hospital. HSS anesthesiologists, radiologists and pathologists participate in most of the same plans as the hospital.

View insurance plan participation and contact information for the following physicians and physician groups:

You should also check with your physician to determine whether the services of any other HSS physicians will be required for your care, so that you may review their insurance plan participation. Your physician can provide you with the contact information of any additional HSS physicians whose services may be needed.