Frequently Asked Questions about CMS Data
On May 8, 2013, the Centers for Medicare and Medicaid Services (CMS) released billing data from 3,300 hospitals around the country. The data revealed variances in those hospitals’ charges for many common procedures. The report raised questions about how hospitals determine prices.
We want you to know that Mercy Medical Center is committed to sharing information that will help people make informed decisions about their healthcare services. We realize that, in this era of increasing healthcare costs and consumer-driven financing alternatives, the need for pricing transparency in healthcare services has taken on increasing importance for Iowa's citizens.
Where can I find pricing information about Mercy Medical Center?
Mercy Medical Center is committed to public information and accountability. Beginning in January 2007, Mercy Medical Center began to voluntarily publicize hospital charge information via the Iowa Hospital Association website. This public portal allows consumers to conduct either basic or more advanced searches of charges associated with all hospital inpatient services, as well as provide the opportunity to compare hospitals to one another.
Visit the Iowa Hospital Association–Charges Compare website for pricing information on hospital services and procedures.
Is there a phone number I can call at Mercy to get pricing information and/or financial assistance?
Yes, Mercy is ready and willing to assist patients with pricing information & financial assistance. If you have a question regarding pricing at Mercy Medical Center, we have Financial Counselors ready to assist. all (319) 398-6856 or (319) 221-8960.
Why do so many variables exist in determining hospital charges?
Each individual patient’s treatment is unique and there are many variables that determine out-of-pocket costs. For example, the patient’s overall health status may alter the treatment or procedure they receive.
How can pricing information become more individualized?
Each individual patient’s treatment is unique and, while best attempts are made to provide pricing prior to the procedure, overall charges may be more/less depending on the patient’s overall health status (diabetes, high blood pressure and other health factors may alter the treatment/procedure).
How commonly do different consumers pay different prices for the same hospital procedure or treatment?
In the majority of cases, what the hospital charges and what the hospital is paid are different amounts. Each insurance payer has a different amount that they cover and there is variation among insurance plans. In addition, each employer has a different amount that they will provide to their employees for deductibles, coinsurance, preventative care, etc. All of these factors result in patients paying varying amounts. Some patients choose high-risk deductible plans and others carry lower amounts.
Where should consumers start if they hope to find a range of costs and cost-comparison information in advance of treatment?
The most direct way to begin the inquiry would be to contact one’s insurance carrier. The insurance company will be able to let you know if the service or treatment is a covered benefit and the amount of the deductible or coinsurance. Additionally, the insurance carrier can advise patients as to whether they authorize the procedure and/or whether a second opinion is needed. The more information you can gather from your insurance plan, the better we can assist you in determining your out-of-pocket expenses.
In many cases, the patient’s physician’s office can call on behalf of the patient to obtain charge information. At Mercy, we welcome patient calls to the hospital where our staff can assist with pricing information. Upon such a request, our staff will help verify the charges as they relate to the patient’s benefits, help the patient understand the billed charge and estimate the patient’s out-of-pocket expense. Again, the more information the patient can provide, the better we can assist. Financial counselors can be contacted at (319) 398-6856 or (319) 221-8960.
Can an underinsured or uninsured patient negotiate with Mercy to pay a discounted rate?
Mercy offers discounted charges to all uninsured patients.
The majority of insured patients receive a discounted rate equivalent to the insurance company’s allowed amount. If financial assistance is needed for deductible or coinsurance payments, an application for additional assistance needs to be completed. These applications are available by contacting the financial counselors at (319) 398-6856 or (319) 221-8960.
Mercy provides an average of $1.4 million per month in financial assistance and charity care to those in need in our community. Mercy offers full and partial write-offs up to 1000 percent of federal poverty guidelines for determining free and discounted care.