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Guide to Understanding Health Care Prices

Many of our patients are concerned about what their health care services will cost. We understand that this uncertainty can be stressful and make it hard to plan your personal or household finances. University of Missouri Health Care’s intent is to make this information more accessible to our patients. We hope that the information provided in this section will help you make a more informed choice about your health care. Our goal is for our patients to have a better understanding of their health insurance benefits and what their share of the cost will be.

In today’s health care market, patients (members) are expected to cost-share more than they have in the past. Helping you know your share and what you will be expected to pay is more important today than ever. One purpose of sharing health care cost information is to encourage people to make better health care choices and reduce the potential of selecting care that is of limited benefit.

➪ Quality matters, too

Price in health care should not be your only consideration. University of Missouri Health Care is focused on creating a health care environment known for excellent, safe and effective patient-and-family-centered care. When choosing a hospital, patients should consider many factors. Among the most important factors are quality of care and patient safety. For those reasons, University of Missouri Health Care follows rigorous quality, patient safety and service practices throughout all our hospitals and clinics.

MU Health Care is proud to have received several awards and recognitions including the 2014 UHC Quality Leadership Award. MU Health Care is ranked among the 12 top performing academic medical centers in the 2014 Quality and Accountability Study by the University HealthSystem Consortium (UHC) for delivering high-quality, safe, efficient, patient-centered and equitable care.

➪ Price is linked to your insurance coverage

The amount you will pay for care will depend on the health insurance plan you have. If you have health insurance, you and your insurance plan will share in the cost for your care. Cost-sharing includes copayment, deductible and coinsurance. The level of benefit will determine how much you will pay and how much your health insurance plan will pay.

Another factor in the price of your care is the network you are in. You will want to be sure University of Missouri Health Care is in-network with your health plan. If not, you will want to find out how your out-of-pocket costs will be affected if you use an out-of-network provider. The price you pay is typically lower when you receive care from an in-network provider.

➪ Get an estimate when you can plan ahead

When you can schedule a health care service or procedure ahead of time, it will allow you the best opportunity to take financial considerations into account. For example, you can plan ahead when you choose to have an elective procedure, such as a knee replacement.

➪ Get the specifics

Ask your health care team about the following:

  • the technical name of the procedure you will be having
  • the insurance codes
  • a list of tests you may need before the procedure
  • how long your hospital stay is expected to be for this procedure if you will be hospitalized
  • follow-up care you will need, such as rehabilitation or therapy

➪ Insurance codes: What you need to know

In health care, providers and health insurance plans use several types of codes to communicate with each other about payment. The codes are designed to make sure that billing and payment are correctly handled. To get a price estimate, you should have the following code information:

  • ICD-9 or ICD-10 code. (International Classification of Diseases) These codes identify your health condition or diagnosis. For example, 250.0 means diabetes with no complications; 493.0 is the code for asthma.
  • CPT code. (Current Procedural Terminology) These codes are numbers that are often used on medical bills to identify the charge for each service and procedure billed by a provider to you or your insurance plan.

➪ Request the estimate.

Download and print an estimate request form

Once you have your details, look to your health insurance plan for a price estimate. Visit the website for your health plan. Some plans have estimate tools online for their members.

If the information you need is not available online, you might be able to might be able to find this information by calling the insurance company’s customer service number. This number is usually printed on the back of your insurance card. Be sure to have your card available when you call.

➪ Know the limitations of an estimate.

A price estimate from University of Missouri Health Care will include the following specific information if you do have insurance:

  • The procedure codes used to prepare your estimate
  • The median price and price range for the procedure estimated, based on historical data
  • The total price for your care and the portion of that price you are expected to pay, with the self-pay discount applied

If you have health insurance, a price estimate from University of Missouri Health Care will include the following specific information:

  • The procedure codes used to prepare your estimate
  • The median price and price range for the procedure estimated, based on historical data
  • The total price for your care and the portion of that price you are expected to pay based on the benefit information available at the time the estimate is prepared

There is always a chance that the bill you receive will turn out higher than the estimate. The estimate information provided by University of Missouri Health Care will be a best ESTIMATE based on the information you have provided. It is not a guarantee of what you will be charged. Please understand that in many cases, it is impossible to predict the final charges that will result because there are factors that may vary in your actual services – variations such as length of time spent in surgery or recovery; specific equipment, supplies and medications required; additional tests required by your physician; and/or any unusual special care or unexpected conditions or complications. If you have health insurance, your benefits will ultimately determine the amount you owe (including deductibles, co-payments, co-insurance and out-of-pocket maximums).

If you do not have insurance, you may be eligible for a payment plan or financial assistance.

Get more information on payment plans.

Get more information on our financial assistance policy

➪ Be aware that some services are not covered.

You will be responsible for paying the full amount due for any health care service, procedure or products that are not covered by your health insurance plan. Examples include Lasik surgery, cosmetic surgery, fertility testing and services or procedures considered experimental by your health plan.

Generally, non-covered services do not count toward your annual out-of-pocket maximum under your health insurance plan. Check with your health insurance plan for more details.

➪ Price estimates and information

We are committed to providing you with meaningful information about what health care services may cost you based on your personal health care coverage. We strive to present this information in a way that will be easy for our patients and consumers to access and understand.

If you are insured (have some form of insurance or government coverage, like Medicare or Medicaid): Your health insurance plan provider should serve as your primary source for price information. This is now a service provided by major insurance carriers. You should contact your insurance company to ensure that the services you are seeking are “covered services.” If a procedure is not a covered service under you plan, please refer to our information for persons who are uninsured.

If you are uninsured (without insurance or coverage): As your provider of health care, University of Missouri Health Care is committed to being your primary source of price information. We are committed to providing you a pre-service price estimate for a standard procedure without complications. If there are complications or other unforeseen circumstances, the price may then be more. All price estimates posted on our webpage includes the hospital’s uninsured discount.

Many people without health insurance are concerned about what the services in clinic will cost them. University of Missouri Healthcare (MUHC) wants to give you a better understanding of the share of your cost.

We cannot give you an exact total cost of care prior to a visit as it depends on the kind, severity and number of problems you address with your doctor privately in the office visit. However, we can give you some general information and definitions.

Terms to Know

  • New patient: person that has not been seen in the physician’s office for 3 years or who has never been seen in that clinic practice group (.e.g. Family Medicine, Missouri Orthopedic Institute, etc.).
  • Established patient: person that has been seen in the physician’s office or that practice group within the past 3 years.
    Note: The charges are different depending on if you are new or established patient.
  • CPT code: unique number assigned to specific medical service and procedure.
  • Physician Charge: is the charge of the health professional that cared for you.
  • Hospital Charge: is the charge by University Hospital for facility, ancillary testing, and costs for supplies.
  • Combined Charge: is the total of University Physician fees and University Hospital fees.
  • Deposit: the amount we ask that you pay as a deposit toward the total charges for your care, requested at the time of the visit before the visit begins.
  • Uninsured discount: if you have no health insurance or third party liability, you will be eligible for the self-pay discount from your total charges. (University Hospital 60% discount; University Physicians 25% discount plus additional 20% discount if paid in full within 30 days.
  • The physician and hospital will bill separately for the services provided. As a result, you will receive two (2) separate bills for services provided in the clinic that we expect you to pay - one from the doctor and one from the hospital.

Below are examples of office visit charges. The level of office visit and amount you may owe will depend upon the kind, severity and number of problems you address with your doctor privately in the office visit.

Estimated Charge with Self Pay Discount

    CPT Code Physician Charge Hospital Charge Combined Charge Deposit at time of service
New Patient Office visit 99202 $90.00 $36.40 $126.40 $50.00
New Patient Office visit 99203 $138.75 $36.40 $175.15 $50.00
New Patient Office visit 99204 $234.75 $36.40 $271.15 $50.00
New Patient Office visit 99205 $305.25 $36.40 $341.65 $50.00
Established Patient Office visit 99212 $51.75 $36.40 $88.15 $50.00
Established Patient Office visit 99213 $91.50 $36.40 $127.90 $50.00
Established Patient Office visit 99214 $141.75 $36.40 $178.15 $50.00
Established Patient Office visit 99215 $201.00 $36.40 $237.40 $50.00

* The charges for the hospital support the cost of the clinical and other support staff, the equipment and facilities in the clinic, and ultimately support our organizational missions of patient care, education and research. It does not include the cost of the physician and their related operating expenses which is billed separately.

** Note: Some clinics may require a deposit at time of service.

If you are unable to pay your bill in full, you may be eligible for a payment plan or financial assistance. For information on payment plan options contact Customer Service at 573-884-3300. If you will need additional financial assistance you may discuss options with Customer Service or one of our Financial Counselors.

Below are examples of common procedures performed or ordered during a clinic visit and the amount you may owe. Charge listed below does not include supplies, dyes or contrast used in delivery of this service.

Charges valid through July 1, 2016

Common Outpatient Procedures and Tests

Estimated Charge with Self Pay Discount

  CPT Code Hospital fee Professional fee Combined
Basic CT (Cat) Scan
CT Head/brain w/o contrast material 70450 $182.80 $137.25 $320.05
CT Thorax w/ contrast material (chest) 71260 $366.40 $179.25 $545.65
CT Cervical Spine w/o contrast material 72125 $182.80 $168.00 $350.80
CT Lumbar spine w/o contrast material 72131 $182.80 $168.00 $350.80
CT Abdomen & pelvis w/o contrast material 74176 $360.40 $197.25 $557.65
CT Abdomen and Pelvis w/ contrast material 74177 $571.20 $206.25 $777.45
Basic MRI
MRI Brain/Brain stem w/o w/ contrast material 70553 $734.40 $411.75 $1,146.15
MRI Spinal Canal Thoracic w/o contrast material 70551 $435.60 $231.75 $667.35
MRI Spinal Canal Lumbar w/o contrast 72148 $435.60 $214.50 $650.10
MRI Spinal Canal Cervical w/o & w/ contrast material 72141 $435.60 $231.75 $667.35
MRI Any Joint lower extremity w/o contrast material 73721 $435.60 $195.75 $631.35
Cystography minimum 3 views RS&I 74430 $495.20 $46.50 $541.70
US Breast Limited 76642 $176.40 $61.50 $237.90
US Abdominal real time w/image limited 76705 $205.20 $84.75 $289.95
Basic X-ray
X-ray Exam Chest 2 views frontal and lateral 71020 $90.40 $32.25 $122.65
X-ray Exam Spine Lumbosacral 2/3 views 72100 $101.20 $33.00 $134.20
X-ray Exam Pelvis ½ views 72170 $101.20 $33.00 $134.20
X-ray Exam Shoulder Complete minimum 2 views 73030 $101.20 $36.00 $137.20
X-ray Exam Wrist Complete minimum 3 views 73110 $90.40 $24.75 $115.15
X-ray Exam Hand minimum 3 views 73130 $90.40 $24.75 $115.15
X-ray Exam Hip Unilateral w/ Pelvis 2-3 views 73502 $92.80 $30.75 $123.55
X-ray Exam Knee 1/2 views 73560 $90.40 $26.25 $116.65
X-ray Exam Knee 3 views 73562 $101.20 $27.75 $128.95
X-ray Exam Knee Complete 4/more views 73564 $101.20 $33.00 $134.20
X-ray Exam Ankle Complete minimum 3 views 73610 $101.20 $24.75 $125.95
X-ray Exam Foot Complete Minimum 3 views+A22 73630 $90.40 $24.75 $115.15
X-ray Exam Abdomen 1 Anteroposterior View 74000 $90.40 $25.50 $115.90
DXA Bone Density Study 1/> Sites Axial Skel 77080 $144.80 $37.50 $182.30
Screening Mammography
MA MAMMO 2-D Digital Screening Bilat ALL-BI G0202 $74.80 $74.25 $149.05
CAD (Computer-Aided Detection) w Screening MAMM-XS 77052 $13.60 $9.00 $22.60
Laboratory Testing
Glucose Blood by Monitoring Device NSFM 82962 $8.30 $3.00 $11.30
Blood Count Complete (CBC) Auto & Auto Differential WBC 85025 $19.04 $7.50 $26.54
Comprehensive Metabolic Panel 80053 $40.00 $10.50 $50.50
Urinalysis Dip Stick only 81003 $7.40 $2.25 $7.37
Lipid Profile 80061 $32.80 $20.25 $53.05
Urinalysis w/ Microscopic 81001 $7.76 $3.00 $10.76
Prothrombin Time 85610 $13.92 $3.75 $17.65
Thyroid Stimulating Hormone (TSH) 84443 $59.48 $16.50 $75.96

➪ Uninsured discount

If you are uninsured (have no health insurance or third-party liability), you will be eligible for self-pay discounts from your total charges (University Hospital 60% discount; University Physicians 25% discount, plus an additional 20% discount if paid in full within 30 days).

➪ Our commitment to price transparency and information

It is the policy of University of Missouri Health Care’s hospitals to provide consumer access upon request to hospital standard charges for services obtained across hospitals and clinics in compliance with the Affordable Care Act Section 2718c of the Public Health Service Act.

Hospital Charge Transparency policy

The Missouri Hospital Association provides a website, Focus on Hospitals, with details on hospital costs, quality measures and comnmunity health data throughout Missouri.

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