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In accordance with federal law all hospitals, including CarePoint’s, are required to post their “chargemasters” of prices for the services they provide. The chargemaster prices are akin to “list” or “sticker” prices. Like a list or sticker price, the actual price for the listed health care services are almost always dramatically discounted from those listed on the chargemaster. To view our chargemaster, please click the following link:
What Does The Chargemaster Reflect?
It is important to note that a healthcare provider is rarely reimbursed for its price for any service. If you are a patient or a prospective patient, the data contained within the chargemaster will not provide you with the information you need to understand your responsibility for a potential procedure or service. The chargemaster data will also not provide you with the information related to the amount to be paid on your behalf by an insurer or other third party for any procedure or service.
Important Additional Information—Please Read:
CarePoint wholeheartedly supports providing patients and other members of the public with the necessary information concerning a patient’s responsibility with respect to the cost of care as well as what health care providers receive as reimbursement for health care services.
As noted, the charges listed in the chargemaster are not the actual costs that are billed to a patient. The charges represent the amount the hospitals bill the insurer (if you are insured) for the services rendered. Almost all insurers reimburse the hospital at a rate significantly lower than the charges billed by the health care provider.
For patients covered under commercial insurance plans, your deductible or “out-of-pocket” responsibility will depend on your specific plan. Therefore, the only way to understand what your actual cost responsibility will be for a procedure is to contact your insurance carrier directly. In addition, patients that receive emergency services in a hospital should not be “balanced billed” (i.e. for the difference between hospital charges and actual insurance payment to the hospital) for any service provided. You should be only responsible for your deductible or out-of-pocket expenses no matter where you receive care.
For patients covered by Federal and State health insurance programs such as Medicaid and Medicare, the chargemaster posting will likewise not provide useful information related to the cost of care because reimbursement rates to hospitals are established by a fee schedule, and a patient’s responsibility is established by the applicable government program.
If you are an uninsured patient, CarePoint works diligently to strengthen access to care for its underinsured and uninsured patients. Through our Neighborhood Health Centers, anyone can receive personalized, continuous and coordinated medical care – regardless of his or her ability to pay. In addition, New Jersey’s Charity Care program provides free or discounted outpatient care, based on a prospective patient’s income. If you are a patient who wishes to obtain insurance at an affordable or even subsidized rate, The Affordable Care Act and NJFamilyCare Program can help you choose which coverage is right for you.
CarePoint fully supports the goal of transparency in connection with the cost of healthcare. In order to ensure actual transparency, it is necessary for patients and the public to know the amount actually reimbursed and/or paid to health care providers by insurers and other third parties. The publication of a chargemaster without a corresponding publication of what insurers and other third parties pay to hospitals does not inform the public concerning the cost of healthcare services. Insurers and third party payers reimburse hospitals a small percentage of their charges. For hospitals that are located in urban settings, which service significantly more underinsured and uninsured patients than suburban hospitals, the amounts reimbursed by payers and third-parties are typically less than the actual cost of the care provided to patients. Urban hospitals are community assets, and their continued financially viability is closely linked to the amount they are reimbursed and not reimbursed for the critical health services they are counted on to provide.
If you would like additional information about the estimated actual cost of healthcare services provided by CarePoint, please contact our Insurance Help Desk at 866-261-0801 Monday through Friday from 9 a.m. to 5 p.m.