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Welcome to Texas PricePoint
Welcome to Texas PricePoint, a user-friendly resource for information on Texas hospitals. Texas PricePoint
is sponsored by the Texas Hospital Association, an Austin-based nonprofit statewide trade association
representing hospitals and health systems. This site was created to provide basic demographic, quality and
charge information on Texas hospitals and to promote consumer/hospital interaction.
Because the consumer's role in managing his/her own health care is changing, Texas hospitals made a
commitment to provide information regarding hospital charges and quality.
Texas PricePoint provides:
- Charge data on the most common inpatient services;
- Links to quality data; and
- General and contact information for Texas hospitals.
The content on this Web site is intended for informational purposes only and should not be used solely when
making health care decisions. All the data on this Web site were collected by the Texas Department of State
Health Services, a state agency and independent source, and was not modified in any way by the Texas
Hospital Association or its contractor.
This information can be used as a factual starting point for a more informed discussion among consumers,
insurers and providers of care. This Web site contains information on the most common services and quality
measures only; specific questions you may have might not be addressed here. To receive more specific
information on services for yourself or a family member, please contact your hospital and/or health insurance
provider directly. Also, please talk to your doctor or other qualified health provider about this information to help
you, your family and your friends make the best health care decisions for your specific circumstances.
Things to Know When You Look at Texas PricePoint Reports
IF YOU HAVE COMMERCIAL INSURANCE ...
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Commercial insurers negotiate discounts with hospitals on behalf of the
patients they represent. The discounts vary among insurers.
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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 to a hospital.
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Begin by contacting your insurance company to understand all of the factors
affecting your financial responsibility.
IF YOU HAVE MEDICARE ...
- Medicare pays hospitals according to a set fee schedule that represents a
discount from a hospital’s 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, a spouse's job or coverage thru a Medicare HMO/PPO.
- If you have a supplemental insurance policy, it may cover some costs Medicare
does not cover.
- Contact Medicare at http://www.medicare.gov/
IF YOU HAVE MEDICARE MANAGED CARE (PPO or HMO) ...
- Medicare Choice plans and PPOs negotiate discounts with hospitals on behalf of
the patients they represent. The discounts vary among the plans or PPOs.
- 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 Medicare Choice plan’s network
– also will affect your financial responsibility to a hospital.
- Begin by contacting your Medicare Choice plan or PPO to understand all of the
factors affecting your financial responsibility.
IF YOU HAVE MEDICAID ...
- Medicaid managed care plans and Children’s Health Insurance Program (CHIP)
plans negotiate discounts with hospitals on behalf of the patients they
represent. The discounts vary among the plans.
- Numerous factors, such as type of plan, co-pays if applicable, out-of-pocket
maximums and any limitations on coverage under your Medicaid managed care plan
or CHIP also will affect your financial responsibility to a hospital.
- Begin by contacting your Medicaid managed care plan or CHIP plan to understand
all of the factors affecting your financial responsibility.
IF YOU HAVE MEDICAID MANAGED CARE (STAR, STAR+PLUS) OR CHIP ...
- Medicaid managed care plans and Children’s Health Insurance Program (CHIP)
plans negotiate discounts with hospitals on behalf of the patients they
represent. The discounts vary among the plans.
- Numerous factors, such as type of plan, co-pays if applicable, out-of-pocket
maximums and any limitations on coverage under your Medicaid managed care plan
or CHIP also will affect your financial responsibility to a hospital.
- Begin by contacting your Medicaid managed care plan or CHIP plan to understand
all of the factors affecting your financial responsibility.
IF YOU ARE UNINSURED ...
- 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 assests to determine whether or not you qualify for full or partial
financial assistance.
- Access on-line information provided by the Texas Department of Insurance
to help you shop for health care coverage at www.texashealthoptions.com.
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