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Price estimates

How much will my exam, procedure, or hospital stay cost?

Determining your individual out-of-pocket costs for healthcare services often includes a wide range of variables - such as your insurance provider (company/carrier), your specific coverage plan, and your expected deductibles or co-payments. To better understand your potential out-of-pocket costs, we encourage you to speak with one of our Customer Service Representatives. They are financial experts who are willing and able to answer your questions.

Help with cost questions: 812.801.0161

Regular business hours are Monday - Friday, 8:30 a.m. - 4:30 p.m. You may also visit us in person. Our Business Operations Center is located at 701 Broadway in downtown Madison. A financial representative is also available inside the Hospital Entrance at the main campus, 1373 East SR 62.

Understanding Hospital Billing

Question: How does hospital billing work?
Answer: Hospital billing is complex and based on many factors, such as staffing, equipment, maintenance costs, and the difference in care needed by each patient. Additionally, hospitals are prepared with doctors, nurses and high-tech equipment around the clock for illness or injury, from a twisted ankle to a major accident. Every patient's case is special and requires different levels of care.

Question: How are hospitals compensated for services?
Answer: Hospitals are often not paid in full for the services they provide. Medicare and Medicaid generally pay less than the actual cost of caring for patients, leaving other patients to make up the difference. There are also patients who, unfortunately, can't pay for their hospital bills. Each hospital has different proportions of Medicare, Medicaid, commercial or uninsured patients, which adds to the complicated nature of hospital billing. Every insurer, whether Medicare, Medicaid or commercial, pays the hospital differently.

Medicare and Medicaid

Question: What are Medicare and Medicaid?
Answer: If you have Medicare or Medicaid, the government sets the rates for how much is covered. Like commercial insurance, there may be some out-of-pocket costs.
Medicare is a health insurance program for people age 65 or older or people under 65 with certain disabilities or conditions.
Medicaid is a joint federal and state program that helps with medical costs for people with low incomes.

Charge Definition: The amount a hospital sets for total services provided to the patient before any insurance discounts. Similar to a "sticker price," it is usually not the final amount paid.
Reimbursement: The amount Medicare or Medicaid pays to the hospital.
Out of pocket costs: The amount a patient pays to the hospital (for example, deductible or co-pay).

EXAMPLE

Example of a Medicare charge breakdown: General Surgery total charge: $38,000
Hospital reimbursement: Medicare: $6,800
Out of pocket costs: Medicare: The 2018 Medicare deductible for an inpatient stay is $1,340
In this example, the hospital will receive $8,140 for a $38,000 charge. This illustrates that the charge or "sticker price" is often not the final amount paid.

Commercial Insurance

Question: What is commercial insurance?
Answer: If you have commercial insurance, insurers negotiate payment rates with hospitals. These rates can differ among companies, where larger insurers tend to demand bigger discounts. The demands for discounts by commercial insurance companies create further complexity for hospitals and patients to determine the true cost of any given procedure. Commercial insurers do not pay full hospital charges. Furthermore, numerous factors, such as the type of plan, co-pay amount, co-insurance amount, out-of-pocket maximums and other limitations will affect the individual's financial responsibility to a hospital. Therefore, it is crucial that you begin by talking to your insurance company to understand all of the factors affecting your responsibility.
KDH Customer Service representatives can assist you. Please call 812.801.0161 (Monday - Friday, 8:00 a.m. - 4:30 p.m.)

Charge Definition: The amount a hospital sets for total services provided to the patient before any insurance discounts. Similar to a "sticker price," it is usually not the final amount paid.
Reimbursement: The amount a commercial insurer pays to the hospital for an inpatient stay from the commercial insurance provider. Rates are negotiated between the insurance company and the hospital.
Out of pocket costs: The amount a patient pays to the hospital after reimbursement from commercial insurance (for example, deductible or co-pay).

EXAMPLE

Example of a Medicare charge breakdown: General Surgery total charge: $38,000
Hospital reimbursement: In this example, the insurance company has negotiated a discount with the hospital. Therefore, the hospital will receive $26,600 from the insurer.
Out of pocket costs: Commercial insurance deductible is $1,000.
In this example, the hospital will receive $26,600 for a $38,000 charge. This illustrates that the charge or "sticker price" is often not the final amount paid.

Self-Payment

Question: What is self-payment?
Answer: Self-payment is when a patient pays for health-related services when they don't have insurance to cover medical treatment or surgery. For patients who do not have insurance, hospitals typically have Financial Assistance Programs for patients who qualify. Contact a KDH Customer Service Representative to learn more about what available programs and options. Call 812.801.0161.

Charge Definition: The amount a hospital sets for total services provided to the patient before any insurance discounts. Similar to a "sticker price," it is usually not the final amount paid.

Pricing Information

The information provided in the links below is a comprehensive list of charges for each inpatient and outpatient service or item provided by King's Daughters' Health, also known as a Chargemaster. It IS NOT a helpful tool for patients to comparison shop between hospitals or to estimate what healthcare services are going to cost them out of their own pocket.

For more information, please contact a KDH Customer Service Representative: 812.801.0161.

Chargemaster (PDF)

Chargemaster (CSV)

DRG Average Charge (CSV)

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