Price Transparency

Price transparency is the ability for you, as the healthcare consumer, to access provider specific information on the price of healthcare services, including out of pocket costs, regardless of the setting in which they are delivered.

All patients with health insurance need to pay the deductible, copay, and/or coinsurance set by their health plan. Your health plan establishes these amounts and Catholic Medical is not able to change them.

Your financial obligation could differ depending on whether the hospital or physicians you choose are “out of network,” meaning your health plan does not have a contract with them. Catholic Medical Center has contracts with any health plans, but not all. Contact your insurance company to understand what your financial obligations will be.

All patients without health insurance should discuss financial assistance options available at Catholic Medical Center. These options range from a complete write off of all charges to a substantial reduction of the charges in accordance with our financial assistance program.

Health plans such as Medicare, Medicaid, workers’ compensation, and commercial health insurance, do not typically pay charges. Instead, they pay a set price that has been predetermined or negotiated in advance. You only pay the out of pocket amounts set by your health plan based on these negotiated amounts.

Deductible means the amount that you need to pay for healthcare services before your health plan begins to pay. A deductible may not apply to all services.

Important to remember: Your specific healthcare plan coverage, including the deductible, copay and coinsurance, varies depending on what plan you have. Health plans also have differing networks of hospitals, physicians and other providers that the plan has contracted with. You will need to contact your health plan for this specific information.

Copay means a fixed amount (e.g., $20) you pay for a covered healthcare service, such as a physician office visit or prescription.

Important to remember: Your specific healthcare plan coverage, including the deductible, copay and coinsurance, varies depending on what plan you have. Health plans also have differing networks of hospitals, physicians and other providers that the plan has contracted with. You will need to contact your health plan for this specific information.

Coinsurance means the percentage you pay for a covered health service (e.g., 20% of the bill). This is based on the allowed amount for the service by your health plan. You pay coinsurance plus any deductibles you owe.

Important to remember: Your specific healthcare plan coverage, including the deductible, copay and coinsurance, varies depending on what plan you have. Health plans also have differing networks of hospitals, physicians and other providers that the plan has contracted with. You will need to contact your health plan for this specific information.

Total charge is the amount set before any discounts. Hospitals are required by the federal government to utilize uniform charges as the starting point for all bills. 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, it is the total expense incurred to provide the healthcare. 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, seven days a week, and needs to have everything necessary available to cover any and all emergencies. Non hospital healthcare 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;
• Medical education programs to train physicians, nurses and other healthcare professionals, again provided at a loss;
• More patients with significantly higher levels of illness, that standard 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 can be significantly less than the cost of care. Consider the following information:

• Medicare and Medicaid pay hospitals according to a set fee schedule depending on the service provided, and these amounts are much less than the hospital’s total charges and sometimes actually less than their costs.
• Commercial insurers negotiate rates, i.e. discounts from the hospitals charges, on behalf of their enrollees and pay hospitals at varying discount levels, which can be much less than the actual cost of care provided to patients.
• New Hampshire hospitals provided over $540 million in free and discounted care measured at cost in 2016.

There can be variations, sometimes large ones, in the prices that hospitals set for the same procedure or service. This difference is due to the many factors that go into determining the cost of hospital services and that each facility has its own set of factors to manage which determines its cost structure. Some organizations have higher cost structures due to the complexity of the service being provided, such as trauma, transplant, or neonatal intensive care, that are extremely expensive to maintain. Some organizations have mission related costs, such as teaching, research, or providing care for low income populations. 

Charge information is not necessarily useful if you 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.

If you have the specific insurance codes for services requested, available from your physician, you 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.

If you need an estimate for a specific procedure or operation, please contact the patient financial services office at 603.663.6922.

Such an estimate will be an average charge for the procedure without complications. It is important to understand that your physician or physicians will make the actual determination regarding the specific care you need based on your diagnosis, general health condition, and many other factors. For example, you may require only a one day hospital stay for a particular procedure, while another patient may require a two day stay for the same procedure due to underlying medical condition.

Remember, if you have health insurance, you will only pay the specified deductible, copay, and coinsurance amounts established by your health plan. If you don’t have health insurance or sufficient financial resources, you may be eligible for significant discounts from charges. Please contact the patient financial services office for further information.

If you don’t have health insurance coverage but need to schedule a hospital visit, contact the Patient Financial Services department to discuss the out of pocket costs you can expect, financial assistance and discount programs available.

Covering New Hampshire
This resource provides information about the Health Insurance Marketplace and the affordable health insurance plans that are available.

ACA Marketplace
The Affordable Care Act’s online marketplace is a place where you can shop for health insurance to find the one that best suits your needs.

Granite Advantage Home
To determine your eligibility and / or apply for coverage for the Granite State Advantage Plan, a healthcare program that expands coverage to low income NH residents, or for Medicaid.