Pricing Transparency

Most people want to know the costs of medical treatments or surgical procedures provided prior to scheduling the procedure. The following link will address most of the questions you may have about the cost of treatment at Northwest Florida Community Hospital.

PAYERGLASS

Our goal is to provide information to you that will help you:

• Contain your healthcare costs
• Stay informed about your health care decisions and financial responsibilities
• Reduce the unknown price variations in the healthcare system.

We can provide an estimated average price for most medical or surgical procedures or treatments.

• This average is calculated from the average of costs for patients that are insured and uninsured and is based on the most recent calendar year and the most common inpatient admissions, outpatient treatments, surgical and diagnostic procedures.
• These estimated fees will not include fees from specialists such as pathologists, radiologists, and physician fees. These bills will be sent to you directly from the provider and are separate from hospital charges.
• These fees will also vary from actual charges on the final bill as this will only be a good faith estimate based on information provided at the time of the request.

You have a right to receive a personalized good faith estimate for services and may do so by calling our Financial Counselor at (850) 415-8165 between the hours of 8:00 am and 4:30 pm Monday thru Friday.

Please have the following information ready:

• Description of services needed: tell us what type of procedure or treatment you physician has recommended.
• Type of service needed: tell us if you expect to have your treatment as an outpatient (meaning you return home the same day as your treatment) or if you will need an inpatient overnight stay.
• Physician / Specialist name: tell us your healthcare provider’s name.
• Your Insurance Card: we will need information contained on your card.
• Your Deductible, Coinsurance, Out-of-Pocket Max payment, and Maximum payment:  (This information should be contained on your insurance card or policy.)
• Policy holder’s personal information: we will need to verify name, date of birth, and social security number of the person named as the primary insurance policy holder to check your benefits.

Consumers with health care insurance will be billed depending on their health care insurance benefits.

What are the financial responsibilities of insured patients?

• Deductible:   The amount you owe for healthcare services before your health insurance plan begins to pay. For example, if your deductible is $100, your health insurance won’t pay anything until you have paid $100 for healthcare services.
• Co-pay:   The fixed amount of out-of-pocket costs you pay when visiting the doctor’s office for a particular healthcare service. For example, if your co-pay is $20 then you must pay $20 per visit regardless of the reason for seeing your doctor, and your insurance will pay the rest.
• Co-insurance:   The amount of covered benefits that you are responsible for paying after reaching your deductible amount. For example, if your co-insurance is 20% of medical costs and your total bill is $100, you pay $20 and your insurance company is responsible for $80.

What is the difference between a covered and non-covered service?

• Some services are paid for by your insurance company and some are not. This will depend on your specific insurance company and insurance policy.

If I do not have healthcare insurance, what should I do?

• Please call our Financial Counselor at 415 – 8165 to discuss your options.
  • Depending on your earned income, poverty guidelines and other qualifying information, you may qualify for Medicaid, a state-run health insurance plan.
  • If you are able to pay for your care, you may be eligible for a “prompt payment discount” which will give you a discount on charges if you are able to pay promptly.
  • For elective procedures (not emergent) you will be required to pay money before the procedure is performed.
  • Financial assistance may be available for uninsured people who quality based on poverty guidelines. Call 415 – 8165 for information.

Will I receive bills from anyone other than the hospital for my treatment?

• Yes, you may receive additional bills from some providers that provide their services in our hospital (Pathologists, Radiologists, Hospitalists and other Specialists). Please contact them directly to receive a personalized estimate of their costs, billing practices and whether they participate in the patient’s health care plan.

The Agency for Healthcare Administration’s FloridaHealthPriceFinder website (https://pricing.floridahealthfinder.gov) provides average payments for over 200 services bundles. These service bundles include all components of care, including physician, ancillary and hospital payments. The service bundle information is a nonpersonalized estimate of costs that may be incurred for anticipated services. Actual costs are based on the services provided.

Where can I find information on healthcare facility quality measures?

• One of the most common and comprehensive sources for quality data is Medicare’s Hospital Compare website. For more information, visit www.medicare.gov/hospitalcompare/search.html
• The Agency for Health Care Agency is responsible for healthcare licensure and certifications for Florida healthcare providers. For more information, visit: http://ahca.myflorida.com/MCHQ/index.shtml