HEALTH CARE COST IN WARRENSBURG, MO
The price transparency policy of Western Missouri Medical Center (WMMC) is to allow our patients to obtain our standard charges in compliance with the Affordable Care Act, Section 2718(e) of the Public Health Service Act. It is intended to promote transparency for patients to understand their potential financial liability for services obtained at our hospital and to allow a comparison for similar services across hospitals.
Hospital charges are the amounts set before any discounts. The charge is for care without complications. Actual charges may be different for specific patients due to the medical condition, length of time spent in surgery or recovery, necessary specific equipment, supplies or medication, complications requiring unanticipated procedures, or other treatment ordered by the physician. Therefore, actual charges for a specific patient will differ from the listed standard charges.
Price Transparency Estimator
Many patients that seek hospital charge information are interested in knowing what their out-of-pocket financial responsibility will be. This is an opportunity to have important conversations regarding finances. Patients may contact the Business Office at (660) 262 – 7350, Monday – Friday, 8:00 a.m. – 4:30 p.m. for assistance.
If a patient has health insurance, significant discounts have already been obtained by the insurance company and the patient only needs to pay the deductible, copay, and/or coinsurance. Those with health insurance should contact their health plan for specified financial obligations. Those without health insurance can be provided information related to the hospital’s financial assistance policy and any other discounts (e.g. prompt pay) that could be applied. Requests for specific price estimates should be directed to patient accounts for further assistance.
This information is not a quote or a guarantee of what the charges will be for a specific patient’s care. This charge information does not include the professional services provided by a physician or mid-level practitioner who is not employed by the hospital which can include charges associated with radiology, anesthesiology, pathology, hospitalist services as well as emergency room practitioners.
Patients will likely receive separate bills for the physicians and other professionals who provided treatment. These physicians may not be participating providers in the same insurance plans and networks as the hospital. As such, there may be greater patient financial responsibility for these services which are not under contract with the health plan.
Resources for Healthcare Consumers
The Healthcare Financial Management Association has developed guides to help consumers get answers to questions about health care prices, compare prices for a particular service among providers, better understand, plan and manage out‐of‐pocket health care costs. The guide also helps consumers compare hospitals based on quality outcomes.
Consumer Guide to Healthcare Prices
Consumer Guide to Healthcare Prices (Spanish)
Avoiding Surprises in Your Medical Bills
Avoiding Surprises in Your Medical Bills (Spanish)
Frequently Asked Questions:
1. How much will I actually have to pay out of my pocket?
A patient with health insurance needs to pay the deductible, copay and/or coinsurance set by their health plan. The financial obligations could differ depending on whether the hospital or physicians are “out-of-network,” meaning the health plan does not have a contract with them. Contact your insurance company to understand what your financial obligation will be. A patient without health insurance can call to discuss the financial assistance options available.
Please contact WMMC’s patient accounts department at (660) 262-7350 to obtain further information about the discounts available.
Health insurance plan pays:
Health plans such as Medicare, Medicaid, workers’ compensation, commercial health insurance, etc., do not pay charges. Instead, they pay a set price that has been predetermined or negotiated in advance. The patient only pays the out-of-pocket amounts set by the health plan.
If you need help understanding your health bill, please contact the WMMC’s patient accounts department at (660) 262-7350.
2. What do the following health insurance terms mean?
Deductible means the amount the patient needs to pay for health care services before the health plan begins to pay. The deductible may not apply to all services.
Copay means a fixed amount (for example, $20) the patient pays for a covered health care service, such as a physician office visit or prescription.
Coinsurance means the percentage the patient pays for a covered health service (for example, 20% of the bill). This is based on the allowed amount for the service. You pay coinsurance plus any deductibles you owe.
A patient’s specific health care plan coverage, including the deductible, copay, and coinsurance, varies depending on what plan the patient has. Health plans also have different networks of hospitals, physicians, and other providers that the plan has contracted with. Patients need to contact their health plan for this specific information.
3. What is the difference between charges, cost, and price?
Total Charge is the amount set before any discounts. The charges are based on what type of care was provided and can differ from patient to patient for similar services, depending on any complications or different treatment provided due to the patient’s health.
Cost for a hospital is the total expense incurred to provide health care. Hospitals have higher costs to provide care than freestanding or retail providers, even for the same type of service. This is because a hospital is open 24 hours a day, 7 days a week and needs to have everything necessary available to cover any and all emergencies. Non-hospital health care providers can choose when to be available and typically would not provide services that would result in losses. A hospital’s cost of services can vary depending on additional factors such as:
- Types of services it provides since many vital services are provided at a loss such as trauma, burn, neonatal, psychiatric, and others.
- Providing medical education programs to train physicians, nurses, and other health care professionals again provided at a loss.
- More patients with significantly higher levels of illness, yet payment doesn’t cover.
- A disproportionately high number of patients who are on public assistance or uninsured and unable to pay much if anything toward the cost of their care.
Total Price is the amount actually paid to a hospital. Hospitals are paid by health plans and/or patients, but the total amount paid is significantly less than the starting charges.
- Medicare and Medicaid pay hospitals according to a set fee schedule depending on the service provided, much less than the hospital charge and actually less than their costs.
- Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges.
4. How can I use this hospital charge information for comparing prices?
Charge information is not necessarily useful for consumers who are “comparison shopping between hospitals because the descriptions for a particular service could vary from hospital to hospital and what is included in that description. It is difficult to try to independently compare the charges for a procedure at one facility versus another. An actual procedure is comprised of numerous components from several different departments – room and board, laboratory, other diagnostics, pharmaceuticals, therapies, etc.
A patient who has the specific insurance codes for services requested, available from their physician, can better gauge charge estimates across hospitals. Ask your physician to provide the technical name of the procedure that has been recommended as well as the specific ICD and CPT codes for service.
5. How can I get an estimate for a specific procedure?
If you need an estimate for a specific procedure or operation, please contact the patient accounts department at (660) 262-7350. Such estimates will be an average charge for the procedure without complications. A physician or physicians make the determination regarding specific care needed based on considerations using the patient’s diagnosis, general health condition, and many other factors. For example, one individual may require only a one-day hospital stay for a particular procedure, while another may require a two-day stay for the exact same procedure.
Remember that the patient will not pay charges. Rather, the patient with health insurance will only pay the specified deductible, copay and coinsurance amounts established by their health plan. A patient without health insurance or sufficient financial resources may be eligible for significant discounts from charges. Please contact the patient accounts department for further information.
6. Why did I receive two bills for one visit?
It is possible that you may receive services from other health care professionals practicing at WMMC. You may receive separate bills from some of those providers. Our goal is to provide you with quality healthcare, not confuse you with bills. We have tried to consolidate as many of our services on one bill as possible.
Below is a list of providers and services that work with WMMC patients, but bill for those services separately.
Emergency Providers Billing