Griffin Health Services firmly believes that understanding the reimbursement for medical services and procedures allows our patients and their caregivers to make more informed decisions about their healthcare.
Griffin Hospital has engaged a third party to assist in coordinating its adoption of 45 CFR Part 180, CMS-1717-FW, the Centers for Medicare and Medicaid Services hospital price transparency rule (the “Rule”) requiring certain health providers disclose their pricing to patients for a number of standard provider service offerings.
As there are many factors that affect the reimbursement of care – including benefit plans designs and discounts, as well as the nature of services provided, based on each patient’s unique needs, it is possible that the amount reimbursed by an insurer for a procedure varies from the listed reimbursement.
This information contained on this Webpage and the 300 Shoppable Service Tool (the link included below) is the Hospital’s attempt to provide meaningful information to the patient. The amounts included on the 300 Shoppable Service Tool are the expected reimbursement to the HOSPITAL from your insurance company and could be different after your healthcare service are finally rendered.
This amount does not include ANY PHYSICIAN OR PROFESSIONAL FEES. The best way to confirm the amount that the insurer will pay the HOSPITAL and your corresponding responsibility is to contact your insurance company directly either by phone or their website. If you have any other questions or need assistance with your service pricing or you are unsure of the procedure(s) please call the Business Office at (203) 732-1510.
The self-pay rate represents the maximum charge for a patient that is not applying for financial assistance or receiving any other discounts. If you need financial assistance or a potential discount in the self-pay rate, please see our financial assistance webpage located here.
To the maximum extent permitted by applicable law, in no event will Griffin Hospital or its vendors, subsidies, supplier or other third parties it is working with be liable for any direct, consequential, incidental, special, punitive or other damages whatsoever arising our out of or in any way related to any claim regarding (i) the 300 Shoppable Service Tool (ii) the data displayed on the website, or (III) any other claim related to a service price estimate whether based on contract, tort, negligence, strict liabilities or otherwise.
Griffin Hospital is not responsible for inaccuracies due to incomplete or incorrect information entered into the website. By accessing the link below, you acknowledge:
1. You have read the above statement, and understand that there are many factors which impact the cost of care.
2. You understand that a single charge may not represent a complete medical service.
3. You understand that multiple components may be necessary for a complete service (e.g. procedure(s), supplies, and drugs) that are unknown at this time and may not be included in the estimate.
4. You understand that the 300 Shoppable Service Tool includes hospital services only and does not include professional fees and other fees.
5. You understand that Griffin Health provides estimates of charges for hospital services and that you should speak with the Griffin Hospital Business Office for an estimate of charges for a specific service based on my individual circumstances.
6. You understand that Griffin Health is not liable if the costs associated with my care exceed the estimate.
7. You understand that the charges outlined are not meant to be an advertisement for health care services.
8. You recognize that this information does not represent any binding agreement or obligation between parties but is intended to be used for informational purposes only.
What is a Hospital Chargemaster?
A hospital chargemaster is a comprehensive list of a hospital’s products, procedures, and services. Everything from prescription drugs to supplies for diagnostic tests has a unique price listing in the chargemaster. When you receive a bill for your care from Griffin, you may see the full price for the service and supplies based on the Hospital chargemaster.
Hospitals have a complete list of prices (charges) for all of its services and supplies called a chargemaster. Below please find the chargemaster in a machine readable format:
What are Negotiated Rates?
Healthcare insurance companies negotiate rates with the hospitals and pay based on these contracted rates regardless of the charge amount. Negotiated rates may include a portion you are directly responsible for, such as the deductible, coinsurance or co-pay, as well as charges for services not covered by the insurance policy. These rates vary between different health insurance companies. As part of CMS Price Transparency legislation, the Hospital is required to provide the Hospital’s negotiated rates. Please find this information below in machine readable format:
It is important to note:
- The chargemaster does not reflect any discounts negotiated by insurance companies, discounts resulting from financial assistance or the patient’s ultimate potentially payment responsibility.
- It does not provide a quote or guarantee of actual charges e.g. how much it will cost for a specific patient’s care
- It does not account for any variables in a patient’s medical condition, complications, length of stay, use of laboratory test, pharmaceutical, etc.
Shoppable Services
The high degree of variation in charging practices and differences in reimbursement methodologies between insurance payers make it difficult for patients to get the intended full benefit of “pricing transparency.” Medicare wanted to give patients another way to compare prices, so they’ve also asked hospitals to create a list of shoppable services. Medicare defines “shoppable services” as a service that typically can be scheduled by a patient in advance on a non-urgent basis. Medicare has identified 70 shoppable services that all hospitals should include and has asked hospitals to each choose at least 230 additional shoppable services that they perform most frequently.
Every shoppable service will contain an easy-to-understand description of the item or service and include the average negotiated charge for each insurance payer.
Click here to view Griffin Health’s shoppable services.
You’ll also see a specification for whether the procedure is done on an inpatient or outpatient basis, as procedures done on an inpatient basis may incur additional charges, such as room and board charges.
What is a Diagnostic Related Group?
Diagnostics Related Groups “DRGs” is a payment mechanism used by Medicare and some other insurers to reimburse Hospital’s for an Inpatient Stay. DRG’s are categories of care where regardless of the charges, the Hospital is reimbursed based on a specific fee schedule. This document is a listing of the average “charge” per DRG. This file does not represent the actual reimbursement from the insurance company, but the average charge per DRG.
PATIENTS SHOULD ALWAYS CONTACT THE HOSPITAL’S BILLING DEPARTMENT FOR ANY SPECIFIC INFORMATION OR ESTIMATES REGARDING THE COST OF YOUR CARE AND SERVICES AT THE HOSPITAL.
What is the Chargemaster and Diagnostics Related Group (DRG) impact on your bill for care?
When you receive a bill for your care from Griffin, you may see the full price for the service and supplies based on the Hospital chargemaster.
Insurance companies work with hospitals to negotiate discounts on prices/charges (including inpatient DRG’s) for their customers. If you have insurance, you may see an adjusted price/charge. This reflects the discounted amount your insurance company negotiated with Griffin Hospital. Your insurance company is usually billed first and a second billing detailing your responsibility will be sent to you soon after the Hospital receives the insurance payment. This second bill will reflect an adjusted amount called the “allowable amount” which reflects the combined insurance and patient amount to be paid. Any remaining balance after the insurance payment amount is either due by you or a “secondary insurance” company.
If you have been approved for financial assistance, the Hospital bill will reflect the full chargemaster price for your services less any financial assistance discounts.
If you have any questions or concerns in regards to your bill, please call the Patient Accounting Department at 203-732-1510, Monday through Friday from 8:30 am to 5:00 pm.