Understand Your Medical Bill.
North Carolina hospitals are committed to improving access to useful information for anyone making health care decisions.
This information should come from all providers involved in your care, from physicians and hospitals to insurance companies. Hospitals across our state have long supported transparency, not just about price, but also about quality of care. Prospective patients and their families should consider all information – not just price information– when making care choices.
What INFORMATION WILL BE ON THE STATE WEBSITE?
- Average gross charge for DRG This information is the average total charge for certain groups of inpatient procedures if all charges are paid in full. These figures come from each hospital and are based on thousands of itemized prices for specific services, procedures and supplies used to support patient care. It is important to note that hospital gross charges do not represent a payment amount but a beginning price from which different payers negotiate an actual payment. Find out more about hospital charges at http://youtu.be/nh95f4WZ5Q
- Average negotiated settlement This number represents the average amount of payment received from individuals who paid directly for hospital services. Hospitals refer to this as “self-pay.” Hospitals typically provide discounts to patients without insurance.
- Medicaid reimbursement Medicaid is a state program to assist low income residents with their health care bills. Medicaid reimbursement amounts are generally below provider costs and are lower than the payments received from other 3rd party payers. Many hospitals are eligible for supplemental payments, obtained through arrangements with Federal and State Governments, to help make up those shortages. Those payments are also included in the total reported Medicaid payments. You can find out more about Medicaid through the NC Department of Health and Human Services’ website.
- Medicare payments Medicare, a Federal Government payer for the elderly, is the largest payer of inpatient services for many hospitals. The information the state is providing is taken from recent payment information found on the federal Center for Medicare & Medicaid Services website.
Private insurance payments The law requires hospitals first to determine their five largest private insurance reimbursement providers, based on dollar volume of all payments received. For each of those five insurers, hospitals are to report the lowest, highest and average payment values.