At Martin General Hospital, our goal is to provide patients with high quality care and the best possible hospital experience. We know that the billing and payment process may seem overwhelming at times and we want to be as helpful as possible.
To make the process more transparent, we are happy to follow CMS (Centers for Medicaid and Medicare Services) guidelines that require all hospitals to make available a Standard Charge List for products and services provided at the facility.
Before reading the list, please note that:
- The Standard Charge List does not generally reflect what a patient or insurer pays and not what the hospital receives in payment.
- In 2018 Martin General Hospital was paid, on average, less than 15 percent of charges.
- The charges included in the Standard Charge List do not reflect any discounts negotiated by insurance providers or other payment discounts that can greatly reduce the prices.
- What a patient will actually pay (or a patient’s responsibility) may vary depending on his/her individual health insurance plan, deductible amounts and co-pays.
Uninsured or under-insured patients should always consult with our staff to determine if they qualify for discounts. Our financial counselors welcome questions and are available to provide assistance. Contact our Financial Planning Department before your surgery at 252-809-6196 or 252-809-6334.
What is a charge?
A hospital charge is a federally-required maximum “list price” for an item or service that does not reflect any negotiated discount by the insurance provider. Hospitals are required to maintain a catalog of procedures, descriptions and list prices in a complex accounting tool, known as the hospital Standard Charge List.
What do health insurance providers pay?
Insurers (including Medicare, Medicaid, commercial health insurance providers, and others) do not pay the charges listed in the Standard Charge List. Instead, they pay a set price that is negotiated in advance. Every insurance company pays the hospital differently based on their contract. Patients pay only the out-of-pocket amounts set by their insurance providers.
How can I use this hospital charge information for comparing prices?
Charge information, by itself, isn't generally useful to determine how much patients may need to pay, or to compare what a patient might owe a hospital. Discounts and fee schedules are used to determine how much insurance providers pay and may vary from hospital to hospital.
How are charges different from what insurance companies pay?
Again, Medicare, Medicaid and commercial insurance providers negotiate set prices for what they will pay for medical services. In most cases, what your insurance company sets as the reimbursement will be less than the hospital Standard Charge List. For example, the charge for staying in a hospital room for one day may be listed in the Standard Charge List as $1,500, but the negotiated fee agreed upon by the insurance provider may only be $700.
How are charges different from your possible out of pocket costs, like your deductible or co-insurance?
Deductibles and co-pay amounts are based on the reimbursement terms set by your insurance provider for covered services. They are rarely ever based on the actual hospital Standard Charge List.
How can you receive a clearer customized estimate of your actual out of pocket costs?
For more information about your potential out-of-pocket costs, please contact your insurance provider prior to receiving care. Please contact Patient Accounts/Patient Financial Services department at 252-809-6196 or 252-809-6334 during regular business hours to discuss any specific questions or to speak with a counselor about payment options.
The prices included in the price list are correct as of October 10, 2022.
Standard Charge List in CSV Format for services at Martin General Hospital.
(In compliance with CMS guidelines, we are offering our Standard Charge List in a .CSV format which is "machine-readable." It's also readable by people -- the easiest way to do that is to download the file and open it using a spreadsheet program, such as Microsoft Excel, OpenOffice Calc, or Google Sheets.)