Patient plan pays:

A patient with health insurance needs to pay the deductible, copay and/or coinsurance set by their health plan.

Financial obligations could differ depending on whether hospital or physicians are “out-of-network,” meaning the health plan does not have a contract with them. Contact your insurance company to understand what your financial obligations will be.

​A patient without health insurance will discuss options available for financial assistance that could include either complete write-off of the charges or substantial reduction in accordance with the Illinois Hospital Uninsured Patient Discount Act and Memorial Health’s financial assistance program.

Contact the Patient Services Representatives (217-788-3800 or 800-562-2829) to obtain further information about discounts available.

Health insurance plan pays:

Health plans such as Medicare, Medicaid, workers compensation, commercial health insurance, etc. do not pay charges; instead they pay a set price predetermined or negotiated in advance. The patient only pays out-of-pocket amounts set by health plan.

If you need help understanding your health care bill, please contact Patient Services Representatives in Patient Financial Services (217-788-3800 or 800-562-2829).

Deductible means the amount the patient needs to pay for healthcare services before health plan begins to pay. The deductible may not apply to all services.

Copay means a fixed amount (for example, $20) the patient pays for a covered healthcare service, such as a physician office visit or prescription.

Coinsurance means the percentage the patient pays for covered health service (for example, 20 percent of bill). This is based on allowed amount for the service. You pay coinsurance plus any deductibles you owe.

Specifics of patient’s health plan coverage, including deductible, copay and coinsurance, vary depending on what health plan the patient has. Health plans also have differing networks of hospitals, physicians and other providers the plan has contracted with. Patients should contact their health plan for this specific information.

Total Charge: amount set before any discounts. Hospitals are required by the federal government to utilize uniform charges as the starting point for all bills.

Charges: based on what type of care was provided and can differ from patient to patient for the same service depending on any complications or different treatment provided due to the patient’s health.

Cost: for a hospital, cost is total expense incurred to provide the health care. Hospitals have higher costs to provide care than freestanding or retail providers, even for same type of service. This is because a hospital is open 24 hours a day, seven days a week and needs to have available everything necessary to cover any and all emergencies. Non-hospital health care providers can choose when to be available and typically would not provide services that would result in losses. A hospital’s cost of services can vary depending on additional factors including: types of services it provides since many vital services are provided at a loss such as trauma, burn, neonatal, psychiatric and others; medical education programs to train physicians, nurses and other health care professionals, again provided at a loss; some hospitals consistently treat patients with significantly higher levels of illness, yet payment doesn’t cover; some hospitals have disproportionately high numbers of patients who are on public assistance or uninsured and unable to pay much if anything toward the cost of their care.

Total Price: amount actually paid to a hospital. Hospitals are paid by health plans and/or patients, but total amount paid is significantly less than starting charges.

Medicare and Medicaid pay hospitals according to a set fee schedule depending on service provided, much less than the hospital charge and actually less than their costs.

Commercial insurers negotiate discounts with hospitals on behalf of their enrollees and pay hospitals at varying discount levels, but much less than starting charges.

Charge information is not necessarily useful for consumers who “comparison shop” between hospitals because the descriptions for a particular service could vary from hospital to hospital as well as what is included in that description. It is difficult to try to independently compare the charges for a procedure at one facility versus another. An actual procedure is comprised of numerous components from several different departments — room and board, laboratory, other diagnostics, pharmaceuticals, therapies, etc.

A patient who has specific insurance codes for services requested, available from their physician, can better gauge charge estimates across hospitals. Ask your physician to provide the technical name of the procedure that has been recommended as well as the specific ICD and CPT codes for service.