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Understanding Hospital and Physician Charges

Hospitals are required by law to make available information about their standard charges for the items and services they provide.

For specific information regarding charges and insurance coverage, including estimates for an upcoming hospital service, you may contact the Hospital for Special Surgery Insurance Advisory Service at 212.774.2607 or by email through our online form. The advisory service can serve as a liaison service between you, your insurance carrier, and the Hospital to provide information regarding your potential out of pocket responsibilities for copayments, deductibles and co-insurance amounts.

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.

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.

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.

Physician Charges

The physician services you receive in the hospital are not included in the hospital's charges. Your surgeon, medical doctors, and other specialists bill for their services separately and make their own decisions regarding participation in insurance plans and may or may not participate in the same plans as the hospital. Your anesthesiologist (excluding pain management), radiologist, and pathologist participate in most of the same plans as the hospital. View contact and plan participation information for the following physicians and physician groups:

You should also check with the physician arranging for your hospital services to determine the health insurance plans in which he or she participates and whether the services of any other physicians will be required for your care. Your physician can provide you with the contact information of any physicians whose services may be needed.