Understanding the cost of care
Many patients are concerned about the cost of health care services. We understand this uncertainty can be stressful and make it hard to plan your personal or household finances. St. Charles Health System’s intent is to make pricing information more accessible to you. We hope the information below will make it easier for you to make decisions about your health care.
Our goal is to help you learn more about health insurance and out-of-pocket costs. Today's health care market requires everyone to pay more than we have in the past. Knowing your share of the cost and what you'll be expected to pay is very important and will help you avoid selecting care that is of limited benefit.
Quality matters, too
Though the cost of health care is important, it shouldn't be your only consideration. You should consider many factors when choosing a provider and health care system. Among the most important factors are quality of care and patient safety.
Our commitment to price transparency and information
Please know that it is our policy to provide you with information upon your request about hospital standard charges for services obtained across all St. Charles hospitals and clinics. This complies with Affordable Care Act Section 2718c of the Public Health Service Act.
We are committed to providing meaningful information about how much health care services may cost based on your personal health care coverage:
- If you are insured. If you have some form of insurance or government coverage like Medicare or Medicaid, your health insurance provider should serve as your primary source for price information. This is now a service provided by major insurance carriers. You should contact your insurance company to ensure it covers the services you are seeking. If a procedure is not covered under your plan, please refer to our information for those who are uninsured.
- If you are uninsured. If you do not have health insurance or coverage, St. Charles can provide you with a pre-service price estimate for a standard procedure without complications. If there are complications or other unforeseen circumstances, the price may increase. All price estimates posted on this webpage include the hospital’s self-pay discount.
For more information about hospital costs, quality measures and community health data in Oregon, please visit OregonHospitalGuide.org/find-a-hospital, an online resource provided by the Oregon Association of Hospitals and Health Systems.
Things to consider
Cost is linked to your insurance coverage
The amount you pay for care depends on the health insurance plan you have. You and your insurance plan will share the cost of your care. Cost sharing includes, but is not limited to, copayments, co-insurance, deductibles and non-covered services. The level of benefit determines how much you pay and how much your health insurance plan pays.
Your provider network is another factor in the cost of your care. The price you pay is typically lower when you receive care from an in-network provider. Before making an appointment with a St. Charles provider, check to make sure the provider is in-network with your health insurance plan. If the provider is not in-network, ask your insurance how this will affect your out-of-pocket costs.
When possible, schedule health care services and procedures ahead of time. This will allow you to take financial considerations into account. For example, schedule elective procedures in advance so you have time to plan how you will pay for the procedure.
Get the specifics
Before going through a treatment or procedure, ask your health care team for the following information:
- The technical name of the procedure
- The insurance codes (see below)
- The tests you may need before the procedure
- The expected length of your hospital stay if you will be hospitalized
- The follow-up care you will need such as rehabilitation or therapy
What you need to know about insurance codes
Health care providers and insurance plans use several types of codes to communicate with each other about payment. The codes are designed to make sure they handle billing and payments correctly.
To get a cost estimate, you should have the following code information:
- ICD-10 code. ICD stands for international classification of diseases. This is the reason for the service. These codes identify your health condition or diagnosis. For example, E11.9 is the code for diabetes mellitus, type 2 without complications and I10 is the code for hypertension.
- CPT code. CPT stands for current procedural terminology. This is the service we provided. Providers often use these codes on medical bills to identify the charge billed to you or your insurance plan for each service and procedure.
Request a cost estimate
If you do not have health insurance, a cost estimate from St. Charles Health System will include the following information:
- The procedure codes used to prepare your estimate
- The estimated median cost for the procedure based on historical data
- The total cost for your care and the portion of that cost you're expected to pay with the self-pay discount applied
If you do have health insurance, a price estimate from St. Charles Health System will include the following information:
- The procedure codes used to prepare your estimate
- The estimated median price for the procedure based on historical data
- The total price for your care and the portion of that price you're expected to pay based on the benefit information available at the time the estimate is prepare
Once you have your details, look to your health insurance plan for a price estimate. Visit your health plan's website. Some plans have estimate tools online for their members.
If the information you need is not available online, you might be able to find it by calling your insurance company’s customer service number. You can usually find this number on the back of your insurance card. Be sure to have your card available when you call.
Know the limitations of an estimate
There's always a chance the bill you receive will turn out to be higher than the estimate. The estimate information provided by St. Charles Health System will be a best estimate based on the information you provided. It is not a guarantee of what you will be charged.
This only covers services billed/rendered by St. Charles Health System and St. Charles Medical Group. You may receive bills from other providers, such as anesthesiologists or surgeons.
Please understand that, in many cases, it is impossible to predict final charges due to factors that may vary in your actual services such as:
- Length of time spent in surgery or recovery
- Specific equipment, supplies and medications required
- Additional tests required by your physician
- Any unusual special care or unexpected conditions or complications
If you have health insurance, your benefits will ultimately determine the amount you owe (including deductibles, copayments, coinsurance, non-covered services and out-of-pocket maximums). You can learn more about our financial assistance program here
Know that some services aren't covered by insurance
You'll be responsible for paying the full amount due for any health care service, procedure or product that is not covered by your health insurance plan.
Examples of services, procedures and products not covered by health insurance include:
- LASIKTM surgery
- Cosmetic surgery
- Fertility testing
- Services or procedures considered experimental by your health plan
Generally, services not covered by your health insurance plan do not count toward your annual out-of-pocket maximum. Check with your health insurance plan for more details.
Please note: We cannot give you an exact total cost of care prior to a visit as it depends on the kind, severity and number of problems you address with your doctor privately in the office visit. However, we can give you some general information and definitions.
Terms to know
- New patient. This is a person who has not been seen in the physician’s office for three years or who has never been seen in that clinic practice group.
- Established patient. This is a person who has been seen in the physician’s office or practice group within the past three years. Note: The charges are different depending on if you are a new or established patient.
- Current procedural terminology (CPT) code. A unique number assigned to specific medical services and procedures.
- Physician charge. This is the charge of the health professional that cared for you.
- Hospital charge. This is the charge by St. Charles for the facility, ancillary testing and supplies.
- Combined charge. This is the total of St. Charles physician fees and St. Charles hospital fees.
- Deposit. This is the amount we ask you to pay toward the total charges for your care. We request the deposit at the time of your visit before the visit begins.
- Self-pay discount. St. Charles offers a 20% discount to uninsured patients.
For information on payment plan options, please contact the Customer Service department at 541-706-7750. If you need additional financial assistance, you may discuss options with one of our customer service representatives or financial counselors.
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