Holy Name Standard Hospital Charges
In accordance with the requirements of the Centers for Medicare and Medicaid Services (CMS) Price Transparency Final Rule, Holy Name Medical Center provides information on its standard list of hospital charges. You can download a machine-readable file (MRF) of all standard charges (900+ MB JSON format). These are defined by CMS as:
- Gross charge means the charge for an individual item or service that is reflected on a hospital's chargemaster, absent any discounts.
- De-identified maximum negotiated charge means the highest charge that a hospital has negotiated with a third party payers for an item or service.
- De-identified minimum negotiated charge means the lowest charge that a hospital has negotiated with a third party payers for an item or service.
- Discounted cash price means the charge that applies to an individual who pays the self pay rate for a hospital item or service under Holy Name's Compassionate Care Program.
The services are defined by the codes we bill with. DRGs (Diagnosis Related Groups), are used in most cases for inpatient stays. CPT codes are used for outpatient procedures. NDCs (National Drug Codes), are used to define the drug and manufacturer. If you have insurance and would like to know your out-of-pocket rate, please use our Estimator Tool by clicking on the following link.
The information on this site and in the MRF is provided as required by The CMS Price Transparency Final Rule and is not a guarantee of final billed charges. The final billed charges may vary from these estimates for many reasons including the individual patient's unique medical condition, complications, unknown circumstances, other diagnoses and other recommended treatments. Please note that physician services are billed directly by the physicians that are involved in your care, and those charges are not included on this site or in the MRF.
Healthcare is a very complex system, and it's not just a simple matter of setting one standard price that applies to all cases and all patients. We know it can be confusing and frustrating for patients. But here's some information and suggestions for getting the pricing information you need before you find yourself in the hospital.
An important note: Holy Name Medical Center provides medically necessary emergency care healthcare services to all patients, regardless of their insurance status or their ability to pay a medical bill. If you need hospital care, especially in an emergency, don't let financial worries delay you from seeking care.
How are the charges determined?
Holy Name Medical Center strives to maintain fair and rational charges for services that are contained on the Chargemaster. The charge setting process for services, medical supplies, and pharmaceutical items starts with the Hospital's Direct Cost for that particular item or service. Those prices are then adjusted to account for Bad Debts and other deficits caused by shortfalls from Medicare, Medicaid, Charity Care and other payers whose payments for services do not always cover the Hospital's Direct Costs for services. The prices are further adjusted as necessary to comply with certain provisions of our contracts with Insurance Companies that require Charges to be greater than or equal to the negotiated rate for that service or item, otherwise the Hospital could be paid less. Finally the Hospital compares the list of standard charges with other Hospital Facilities in New Jersey. The Web site NJ Hospital Price Compare (www.njhospitalpricecompare.com) also includes a list of charges for New Jersey hospitals, plus additional consumer resources.
Get the Price Info You Need
As a patient, you're Holy Name's most important customer. But in our healthcare system, the person or entity who actually pays the hospital for its services could be an insurance company, or the government or an individual. The pricing can vary for each type of payer, and that's why it's so difficult for hospitals to name a simple, standard price for the services they provide.
To find the most accurate information for you, follow these suggestions:
If you have insurance:
The Affordable Care Act requires insurance companies to provide their customers with pricing estimates for a hospital stay. Hospitals and physicians provide separate bills for their services, but the insurance company's estimate should include both. Be aware that even with health insurance, many patients will have a portion of costs that they will have to pay themselves; these are called "out-of-pocket" costs. If you need hospital care (and if it's not an emergency) take these steps ahead of time:
- Ask your doctor about the specific name of the procedure, the insurance codes and a list of tests or follow-up care you may receive.
- Give that information to your health plan and ask for a price estimate.
- It's also important to ask the insurance company about the network status of the physicians, hospital and other providers that will be part of your care. That includes not only your own doctor but also additional specialists, like anesthesiologists or radiologists that may help care for you in the hospital.
- Also be sure to ask your insurance company if you need pre-approval or pre-authorization for your procedure, and where you stand in meeting any deductibles or other out-of-pocket costs.
- Take advantage of Holy Name's Price Estimator tool to calculate your estimated out of pocket costs for common Hospital services.
If you need emergency care:
All hospitals are required under federal law to provide emergency care to all individuals, regardless of the person's insurance status or ability to pay for that care. In fact, New Jersey has even stronger laws to ensure that everyone will get the hospital care they need. However, those that have insurance coverage or can afford to pay their medical bills will have payment responsibilities. In the case of an emergency, the hospital will first take care of you and stabilize you in the emergency room. Later, a hospital team member will talk with you or a family member about insurance status and other payment issues.
If you're out-of-network:
If you have insurance, be aware that not all hospitals and physicians will be part of your insurance network. That's where the term "out-of-network" comes from. If a hospital or physician is "in network" with your insurance plan, they have agreed to a payment amount for any services. Your share would be part of your copayment or deductible. In addition, New Jersey law ensures that patients receiving emergency care will be assured in-network coverage and rates. However, if you decide to use a hospital or physician that is "out-of-network" for a scheduled procedure, you may be asked to pay more of the bill out of your own pocket. The best way to find out whether a hospital or physician is in your insurance network is to contact your health plan ahead of time.
Holy Name is "in network" with the majority of Insurance Plans offered in New Jersey, for a complete listing please click here.
No Surprises Act:
Centers for Medicare & Medicaid Services (CMS) has instituted regulations to protect patients from surprise medical bills. More details on the No Surprises Act can be found at cms.gov/nosurprises. The No Surprises Act protects patients with insurance through an employer, individual health plan or Health Insurance Marketplace from balance billing for designated services. Details of these balance billing protections can be found in this CMS Disclosure (PDF). Patients with no insurance will be provided a good-faith estimate for pre-scheduled appointments.
If you're on Medicare:
Medicare has many different parts, and not everyone has the same type of Medicare coverage. For example, those who have chosen the Medicare Advantage plan will have different coverage for hospital care than the traditional Medicare Part A. The best way to be sure of what your Medicare plan covers is to call 800-MEDICARE, or visit the Web site at www.mymedicare.gov. You may also check your Medicare & You handbook.
If you're on NJ FamilyCare (Medicaid):
NJ FamilyCare provides no- or low-cost health insurance to individuals based on certain income guidelines, specifically, for those whose incomes are below 133 percent of the federal poverty level. For more information on NJ FamilyCare, contact the N.J. Department of Human Services' Division of Medical Assistance and Health Services at 800-356-1561 or www.njfamilycare.org.
If you don't have health insurance:
Holy Name Medical Center is committed to providing medically necessary care to all who need it, regardless of their insurance status or ability to pay. If you don't have insurance coverage but need to schedule a hospital visit, contact the patient financial services department at 201-833-3157 to discuss the various financial assistance programs available to you at Holy Name and any out-of-pocket costs you can expect. There are many programs available to help.
The Affordable Care Act's online marketplace at www.healthcare.gov is a place to shop for health insurance. In addition, the NJFamilyCare program at www.njfamilycare.org has been expanded to provide coverage to more New Jerseyans, depending on their income. New Jersey's charity care program also provides free or discounted hospital care, based on the patient's income. Ask the hospital's patient financial services or patient access representative about qualifying for NJ FamilyCare or charity care. If you don't have insurance but earn too much to qualify for those programs, talk with a hospital financial services representative to see if you qualify for financial assistance. All New Jersey hospitals have such programs to assist patients with discounts or payment plans.
Holy Name Medical Center is also proud to offer discounts to uninsured patients who do not qualify for any of the federal or state programs noted above under our Compassionate Care Program. With our Compassionate Care Program we can ensure that no uninsured patient will receive a bill at standard charges. To learn more about our Compassionate Care Program or any of our other Financial Assistance Programs please visit our Financial Assistance Web Page.
Questions?
We're here to help. Contact our patient financial services staff at 201-833-3157 Monday through Friday from 8:30 AM to 2:30 PM.
