Here are definitions to some common terms you may see while understanding your cost of care.
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
C
Charge
The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid.
Chargemaster (CDM)
The hospital Chargemaster, also known as a pricemaster or CDM, is a comprehensive list of inpatient and outpatient charges for services and items that a hospital provides to a patient. These include room charges, procedures, surgeries, diagnostic tests, pharmacy items, supplies and implant items as well as other charges associated with the patient’s care. The Chargemaster rates do not necessarily reflect the payment that Hartford HealthCare will receive from an insurance carrier or government payor.
Coinsurance
A coinsurance is the percentage of costs of a covered health care service you pay after you've paid your deductible. You should contact your insurance company, insurance plan, or government payor for specific information about your coinsurance obligations.
Copay
A copayment (“copay”) is a fixed amount you pay for a covered health care service after you've paid your deductible. Copayments can vary for different services within the same plan, like drugs, lab tests, and visits to specialists. You should contact your insurance company, insurance plan, or government payor for specific information about your copay obligations.
Cost
The definition of cost varies by the party incurring the expense:
- To the patient, cost is the amount payable out of pocket for health care services.
- To the provider, cost is the expense (direct and indirect) incurred to deliver health care services to patients.
- To the insurer, cost is the amount payable to the provider (or reimbursable to the patient) for services rendered.
- To the employer, cost is the expense related to providing health benefits (premiums or claims paid).
CPT Code
CPT code is a five digit numeric code which represents procedures and services provided to a patient. These CPT codes are used in the outpatient hospital billing process when submitting claims to the insurance company.
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D
Deductible
A deductible is the amount you pay for covered health care services before your insurance plan or government payor starts to pay. With a $2,000 deductible, for example, you typically pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services while your insurance company pays the rest. Deductibles typically reset every policy period. This is only general information, however, and you should contact your insurance company, insurance plan, or government payor for specific information about your deductible and how it works.
Discounted Cash Price
A hospital’s “discounted cash price” is defined in the new Price Transparency regulation as “the charge that applies to an individual who pays cash (or cash equivalent) for a hospital item or service.” For many items and services, it is identical to a hospital’s “chargemaster” rate. It does not reflect charity care, financial assistance, bill forgiveness, or other applicable discounts that may be available on a case-by-case basis.
DRG
A diagnosis-related group (DRG) is a patient classification system that standardizes prospective payment to hospitals and encourages cost containment initiatives. In general, a DRG payment covers all charges associated with an inpatient stay from the time of admission to discharge.
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F
Financial Assistance
Hartford HealthCare provides free or discounted care to all eligible patients who meet the criteria in our Financial Assistance Policy. This information and much more is located on Hartford HealthCare’s website for patients and visitors. Learn more about the Financial Assistance Policy, Application, and Contact Information.
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M
MS-DRG
This is a classification system (referred to as DRGs) for inpatient discharges and adjust payments under the Inpatient Prospective Payment System (IPPS) based on appropriate weighting factors assigned to each DRG. Under the IPPS, we pay for inpatient hospital services on a rate per discharge basis that varies according to the DRG to which a beneficiary's stay is assigned. The formula used to calculate payment for a specific case multiplies an individual hospital's payment rate per case by the weight of the DRG to which the case is assigned. Each DRG weight represents the average resources required to care for cases in that particular DRG, relative to the average resources used to treat cases in all DRGs
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N
Negotiated Rate
A negotiated rate, also referred to as an allowed amount, is the amount an insurer contracts to pay for a specific procedure or service. This may be more or less than the charge amount reflected on the hospital’s Chargemaster.
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O
Out-of-Pocket Maximum
An out-of-pocket maximum is the most you have to pay (including on deductibles, copayments, and coinsurance) for covered services in a policy period or plan year. Out-of-pocket maximums typically reset every policy period. However, you should contact your insurance company, insurance plan, or government payor to understand for specific information about your out-of-pocket maximum.
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P
Price
The total amount a provider expects to be paid by payers and patients for health care services.
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S
Shoppable Service
A shoppable service is a service package that can be scheduled by a healthcare consumer in advance..
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