Pricing Transparency: Understanding Costs at Warren General Hospital
We understand that health care costs can be confusing, and we’re here to help. At Warren General Hospital, we’re committed to making pricing clear and accessible for everyone. Starting January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) requires all hospitals to share information about charges and payment rates for medical items and services we provide.
Why charges don’t always reflect what you pay
In the past, hospitals set their prices based on detailed lists of items and services used during a patient’s stay or procedure. However, insurance companies, Medicare, and Medicaid now negotiate their own payment rates with hospitals. This means the actual cost of care for patients is determined by these agreed-upon rates, not the original hospital charges.
For example, let’s say a procedure generates charges totaling $1,000. One insurance company might have a contract to pay $500 for that service, while another might pay $450. These negotiated prices determine the amount paid, not the original charges. Any difference between the charges and the contracted rates is considered a contractual discount.
What determines your out-of-pocket costs?
Your personal costs depend on your insurance plan. Your coverage, deductibles, and out-of-pocket maximums all play a role in determining what you’ll pay. If you’re planning an elective procedure, it’s a good idea to contact your insurance company. They can explain your benefits, current deductible status, and provide an estimate of your costs.
Understanding standard charges
CMS defines five types of charges that hospitals must share:
Gross Charge: The full price for an item or service before any discounts or insurance adjustments. These charges may vary based on factors like location, resources, and expertise.
Discounted Cash Price: The price offered to patients who pay out-of-pocket without using insurance.
Payer-Specific Negotiated Charge: The price a hospital has agreed to with a specific insurance company. This is often listed as the “allowed amount” on your Explanation of Benefits (EOB).
De-identified Minimum Negotiated Charge: The lowest negotiated price across all insurance plans.
De-identified Maximum Negotiated Charge: The highest negotiated price across all insurance plans.
How you can view pricing information
To make things easier, we provide two ways to access our pricing information:
All Services: View a full list of charges and reimbursement rates. To download a machine readable file (MRF) and a full list of charges, please click on one of the following links:
Warren General Hospital Pricing
Warren Medical Group Pricing
Shoppable Services: Find pricing for common, straightforward services that patients often schedule in advance. Our online cost estimator tool will help you to estimate the hospital fee for your inpatient or outpatient care. Please click the following link:
Cost Estimator Tool
We’re here to make pricing transparency simple and understandable, so you can focus on what matters most—your health and well-being.