Below is a Q & A based on billing questions we hear most often from
our patients.
How much will I actually have to pay out of my pocket?
For insured patients, health plans such as Medicare, Medicaid, workers'
compensation, commercial health insurance, etc., do not pay charges. Instead,
they pay a set price that has been predetermined or negotiated in advance.
This negotiation is with each insurer at each healthcare organization.
The patient only pays the out-of-pocket amounts set by his/her health
plan. Therefore, a patient with health insurance needs to pay the deductible,
copay and/or coinsurance set by their health plan.
The financial obligations could differ depending on whether the hospital
or physicians are
"out-of-network," meaning the health plan does not have a contract with them. Contact your
insurance company to understand what your financial obligations will be.
If you need help understanding your health care bill, please contact the
Hospital’s Billing Department at 217-466-4517.
What if I don't have health insurance?
A patient without health insurance can discuss discounted healthcare with
our Financial Assistance Coordinator. Call
(217) 466-4257 or visit
Financial Assistance.
What do the following health insurance terms mean?
Deductible
The amount the patient needs to pay for health care services before the
health plan begins to pay. The deductible may not apply to all services.
Copay
A fixed amount (for example, $20) the patient pays for a covered health
care service, such as a physician office visit or prescription.
Coinsurance
The percentage the patient pays for a covered health service (for example,
20% of the bill). This is based on the allowed amount for the service.
You pay coinsurance plus any deductibles you owe.
Healthcare plan coverage
This includes the deductible, copay, and coinsurance and varies depending
on what plan the patient has. Health plans also have differing networks
of hospitals, physicians and other providers that the plan has contracted
with (i.e., in-network, out of network, consulting physician, etc.). Patients
need to contact their health plan for this specific information.
What is the difference between charge, cost, and price?
Total Charge
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 treatments provided due to the patient's health.
Click here to see our list of charges.
Cost
A hospital's cost of services can vary depending on additional factors, such as:
Types of services it provides at a loss, such as emergency room;
Providing community screenings and education programs;
Number of patients with significant illnesses and payment doesn't cover
treatment costs;
Patients who are on public assistance which pays less than the cost of
care provided
Uninsured patients who are unable to pay much if anything toward the cost
of their care.
Total Price
The amount actually paid to a hospital. Hospitals are paid by health plans
and/or patients, but the total amount paid is significantly less than
the starting charges. Medicare pays hospitals much less than the hospital
charge and typically less than their total costs. Medicaid reimbursement
is even lower and significantly below actual cost.
Commercial insurers negotiate discounts with hospitals on behalf of their
enrollees and pay hospitals at varying discount levels, but much less
than starting charges.
How can I use this hospital charge information for comparing prices?
Charge information is not necessarily useful for consumers who 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.
A patient who has the specific insurance codes for services requested,
available from their physician, 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.
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