Financial Transparency

Informed Healthcare Decisions With Price Transparency

To existing Memorial Health patients, thank you for continuing to place your trust in our ability to serve you and your family. For new patients, welcome! Our mission is to improve the health of the people and communities we serve. We are guided by our values – safety, integrity, quality and stewardship – in everything we do.

We're here to help you navigate a new era of price transparency. Memorial Health complies with state and federal guidelines related to price transparency, and provides you with the tools necessary to make informed healthcare decisions.

Choosing healthcare services for you and your family no longer means simply selecting the best providers – it also means considering how the cost of healthcare will impact you. Memorial understands that these financial considerations are a key part of your decision-making process and we have prepared the following to assist you:

  • A price estimator for 300 commonly shopped services 
  • A downloadable, machine-readable spreadsheet that includes our facility reimbursement rates, by insurance payor and plan type. Note that traditional Medicare and Medicaid are excluded from this file. 

Memorial Health reviews our prices yearly to ensure we are market-competitive. Our prices are reviewed annually by our Board of Directors – a diverse group of community leaders who work in the best interest of the people and communities we serve. Together we strive to provide you with the best price for the services you use while in our care. 

We also want our communities to understand how we spend the money we receive. As a not-for-profit organization, each dollar spent by Memorial Health is used to fulfill our mission. Unlike for profit companies, Memorial does not keep any excess profit or pay shareholders. On this page we share with you a breakdown of how we spend all our revenues.

Memorial Health contributes more than $100 million annually in community benefit – aimed at improving community health, helping to further medical research and education and providing financial assistance to those who need it. A more recent, and pertinent, example of improving community health is Memorial’s response to the COVID-19 pandemic by providing testing locations. 

For more detail, review our annual reports. These reports provide more detailed information about how Memorial Health System is fulfilling our mission and being good stewards of our financial resources. 

Price transparency, like your health, is an area best approached as a partnership. Our commitment to you is to provide the appropriate financial resources, in the most transparent way, to help you make the best healthcare decisions for you and your family.

Katie Keim, CPA, FHFMA
Senior Vice President
and Chief Financial Officer

Michael Kos
Vice President, Revenue Cycle


Financial Stewardship

Using our resources wisely not only allows Memorial Health System to remain financially stable, but also allows us to reinvest in our communities and make them healthier. Below is an illustration of how Memorial spends the money it takes in. Every cent we spend is used to support our mission to improve the health of the people and communities we serve – within our walls and beyond.

Essential Facts

Why is Memorial Health disclosing negotiated reimbursement rates?

Memorial Health is disclosing its negotiated reimbursement rates because beginning January 1st, 2021, the Centers for Medicare and Medicaid Services (CMS) requires ALL hospital facilities in the U.S. to disclose these rates to the public.

What is the price estimator and why is it important?

As part of the January 1st, 2021 requirement, CMS requires that ALL hospital facilities provide consumers a listing of 300 shoppable services. Memorial has chosen to partner with Experian to provide a way for consumers to estimate their out-of-pocket expense for these services based upon their insurance information.

Importance of using the estimator rather than gross charge

The gross charge is the amount a Memorial Health hospital would charge when billing for services rendered. The actual amount you would pay is based upon the negotiated reimbursement rate Memorial has with your insurance, as well as the benefit plan you have. These factor into what you would have to pay from an out-of-pocket perspective.

Understanding the role of insurance companies in the machine-readable file

Memorial has many agreements with insurance companies, and not every agreement includes the same reimbursement rates. This leads to many different ways in which a particular service is paid to Memorial by an insurance company.

Using the machine-readable file

Our hospital machine-readable files are complicated. This is due to the numerous ways in which a Memorial Health hospital is reimbursed. Every agreement we have is unique to the insurance company. That uniqueness is realized not only in the amount we get reimbursed – but also the way in which the reimbursement is calculated. Different ways in which we get reimbursed include:

 

  • Percent of charge basis
  • Per diem basis
  • Diagnosis-related group (DRGs) or All patient refined diagnosis-related group (APR-DRG) basis
  • Ambulatory Payment Classifications (APC) or Enhanced Ambulatory Patient Groups (EAPG) basis
  • Fee Schedule basis

Consumers receiving services may use this file to understand how a Memorial facility is reimbursed. However, we cannot and do not include an estimate for your benefit plan. The machine readable file will only give you one piece of the information. You will need to contact your insurance company to understand how your benefit plan will impact your out-of-pocket expense from an estimate perspective.

Standard Charges for All Items and Services

Shoppable Services Price Estimator

For questions, please email the Memorial Health Revenue Integrity department