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 insurance company.

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:
  • Pricing data on the most common inpatient services;
  • Links to quality data on surgical infections and the most common causes of hospitalization; and
  • Demographic information and contact numbers for hospitals.
Where did this information and data come from?
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 TexasHealthOptions.com.

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 or county.

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.
Remember:
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 benefit.

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 financial responsibility.

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 http://www.medicare.gov/.

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).

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