Texas PricePoint Frequently Asked Questions
What is Texas PricePoint?
Texas PricePoint is a consumer-friendly Web site that provides useful
quality and pricing information on Texas hospitals to serve as a factual
starting point for more informed discussions with your hospital, physician or
Why would I need this information? How is it useful to me?
This information is useful to provide facts about hospitals when you need
health care services, if you are new to the area, or if you are choosing a new
health care plan. Texas PricePoint provides:
Where did this information and data come from?
Pricing data on the most common inpatient services;
Links to quality data on surgical infections and the most common causes of
Demographic information and contact numbers for hospitals.
All pricing and financial data on this Web site were submitted by hospitals to
the Texas Department of State Health Services, a state agency and independent
source, and were not modified in any way. Quality information was collected by
the Texas Department of State Health Services, the Centers for Medicare &
Medicaid Services, and the Joint Commission. The data can be found on the Web
sites of these organizations:
Why do some hospitals’ reports contain partial or no data?
Some smaller hospitals may perform only a few of the most common services. For
that reason, organizations have taken steps to protect patient confidentiality
and to take into account small numbers in reporting data. The Texas Department
of State Health Services excludes data for hospitals having very low volumes,
such as fewer than 50 patients in a quarter or fewer than five patients of a
particular gender. In addition, some hospitals in rural counties are not
required to report their data. Hospital Compare does not include data for
hospitals when the number of cases is too small to reliably predict hospital
performance. Joint Commission has complete information only on hospitals that
they accredit. Limited information is provided for non-accredited hospitals.
What if I don't know the meaning of a term used on this Web site?
Click on the help icons.
If you need information about health coverage terms, go to Texas
What if I can't find my hospital?
First check to make sure you spelled the name of the hospital correctly. If you
did and the hospital still did not show up, try broadening your search by city
What is the hospital's average or median charge? Is this how much I will pay?
Because there are so many variables that factor into the cost of a particular
service and every patient represents a unique case, the average and median
charge ranges are displayed to provide a reasonable estimate on what it might
cost for a particular service. The average or median charge is based on actual
billing information during a recent 12-month period.
If you have health insurance, please contact your insurance company directly as
the amount you will pay out of pocket for your services will be based on
individual circumstances surrounding your treatment, your insurance deductibles
and co-pays, and limitations on your benefit package, such as whether or not
the hospital is in your HMO or PPO network, or if the service is a covered
If you are uninsured, for specific information on your cost estimate, please
contact your health care provider. The amount you will pay for your services
will be based on individual circumstances surrounding your treatment and your
ability to pay.
What if I have insurance?
Commercial insurers usually do not pay hospital charges, but negotiate
discounts with hospitals on behalf of the patients they represent. These
negotiated discounts vary among commercial insurers. Numerous factors, such as
type of plan, co-pay, co-insurance, deductible, out-of-pocket maximums and any
limitations on coverage – such as whether or not the hospital is a
participating provider in the insurance plan’s network – also will affect your
financial responsibility. That is why it is crucial that you begin by talking
to your insurance company to understand all of the factors affecting your
What if I do not have insurance?
For patients who do not have insurance, hospitals typically offer discounts.
Some discounts may be based on the patient’s income level and family size. You
should contact the hospital’s business office for information on the hospital’s
policies and how to request a discount. In some cases, you may be asked to
verify income or other assets to determine whether or not you qualify for full
or partial financial assistance.
What if I have Medicare?
Medicare does not pay hospital charges, but pays hospitals according to a set
fee schedule that represents a discount from hospital billed charges. Medicare
will pay for many of your health care expenses but not all of them. Special
rules apply if you have employer group health insurance coverage through your
own job or a spouse's job. If you have a supplemental insurance policy, it may
cover some costs Medicare does not cover. Contact Medicare at
The best information on the Medicare program is the Medicare and You 2007
Handbook (CMS Publication #10050). This booklet explains how the Medicare
program works and what your benefits are. To order a free copy, write to: U.S.
Department of Health and Human Services, Centers for Medicare & Medicaid
Services, 7500 Security Blvd., Baltimore. MD 21244-1850. You also can contact
your local Social Security office for information.
What if I have Medicaid?
Medicaid does not pay what the hospital charges, but pays hospitals according
to a set fee schedule that represents a significant discount from hospital
billed charges. Generally, Medicaid recipients are not responsible for any
portion of the bill. For more information about the Medicaid program, please
contact your local Medicaid office or the Texas Health and Human Services
Commission at http://www.hhsc.state.tx.us
What is Medicaid?
Medicaid is a joint federal and state program that helps with medical costs for
some people with low incomes and limited resources. In Texas, Medicaid
primarily provides coverage for pregnant women and children.
What is Medicare?
Medicare is a federal health insurance program for people age 65 or older or
under 65 years of age with certain disabilities, or End-Stage Renal Disease
(permanent kidney failure requiring dialysis or a kidney transplant).