Questions About Hospital Charges
Helpful Documents
Q: Why May Charges May Differ Between Facilities?

A: There are many reasons that charges may differ between facilities and even between individual patients. Among them are the following:

  • In terms of individual hospital charges, typically the charge structure is established to take into account how rate negotiations take place with the insurance companies. While difference in the prices that hospitals charge for certain services is revealing, the average person typically doesn’t pay anywhere near the full charge.
     
  • In terms of total charges for an individual’s episode of care, many factors can influence the Total Charges when comparing the bills for similar services. These variations are tied to the actual resources used. For example, someone who is healthier with fewer complications may have a shorter length of stay and need less resources during their stay (such as pharmacy, diagnostic tests, stepped-up nursing care, etc.).

If a patient has health insurance, significant discounts have already been obtained by the insurance company and the patient only needs to pay the deductible, copay and/or coinsurance. Patients should contact their health plan directly for their specific financial obligations that aren’t reimbursed by insurance.

If a patient does not have health insurance, significant discounts are available that could result in the care being provided at greatly reduced prices.

Contacting the hospital's patient financial services office can help determine which discounts can be applied.

Q: Is there a minimum threshold for price reporting?

A: Within a 12-month reporting period, the minimum threshold for information to display for a hospital is 20 cases. Hospitals that do not have at least 20 cases annually in a disease or procedure category will be classified as “insufficient data” for purposes of this site. These hospitals will be displayed with an asterisk (*) indicating less than 20 cases, and will be included in the state-aggregate calculation.

Q: Why can’t I find the diagnosis or medical condition I’m looking for?

A: This website includes the 100 most frequent reasons that a patient in Kentucky was put in the hospital overnight, and the 50 most frequent outpatient surgeries statewide. If you do not find the medical condition or procedure you are looking for, contact the hospital of interest for more information.

Q: What about patient privacy and differences between patients?

A: The data that is published on this site does not include any private health information or any information that could be used to identify an individual patient.

In some ways, that is a limitation of the data: it does not reflect how sick a patient may be and how much attention they will need. And for a variety of reasons, some hospitals have sicker patients than other hospitals. This may affect some of their scores, which is why no one should make decisions about health care providers based on averages alone.

Q: Can I use this data to compare hospitals?

A: This information is gathered from all hospitals in the same way following the guidelines set up by the Kentucky Cabinet for Health and Family Services (CHFS). However, patients and families should not rely on this data alone to decide where to get care because other outside factors can affect averages and rates. While differences in the prices that hospitals charge for certain services are revealing, the avreage person typically doesn't pay anywhere close to the full charge. Using the information on this site as a starting point, consumers should discuss their concerns and questions with their physicians and other caregivers.

Q: Are all Kentucky hospitals included?

A: All hospitals are required to report charge information.

Q: How often is this data updated?

A: The data is updated annually.

Q: Why is there only hospital data in this database?

A: At this point in time, the Hospital Compare quality data and charge data from KHA only includes hospital data. The goal of Kentucky Hospitals Care is to fulfill KHA’s commitment to provide you with helpful information to make a more informed choice when selecting a hospital.

Understanding health care costs and charges

Q: What is the best way to understand my bill?

A: Health care billing can be very complex, but there are some ways to check your bills so that you understand what you, your insurance and/or your employer is paying for:

  1. Make sure you have received all services listed, and understand why.
     
  2. Check dosages and amounts for accuracy.
     
  3. Note the total cost of care, and how much your insurance or employer has paid.
     
  4. If you do not understand any part of your bill, ask your health care provider to explain it.
     
  5. This charge information does not include the professional services provided by a physician, surgeon, radiologist, anesthesiologist, pathologist, advanced practice nurse or other independent practitioners.
     
  6. This information is not a quote or a guarantee of what the charges will be for a specific patient’s care.
     
  7. Patients will likely receive separate bills for the physicians and other professionals who provided treatment. These physicians may not be participating providers in the same insurance plans and networks as the hospital. As such, there may be greater patient financial responsibility for these services which are not under contract with the health plan.
Q: How can I save money on my health care?
  1. Don’t use a Specialist or Emergency Room for basic health care.
     
  2. Only use the Emergency Room for true emergencies.
     
  3. Use generic drugs whenever possible; ask your doctor to prescribe a generic first!
     
  4. Seek comparable care in lower cost settings.
Q: What is the difference between charges and costs?

A: The amount a facility bills for a patient's care is known as the charge. This is not the same as the actual cost or amount paid for the care. The amount collected by a health care facility for each service is almost always less than the amount billed. There are three common examples:

  • Government programs such as Medicare and Medicaid typically pay health care providers much less than the billed charge. These payments are determined by government agencies. Hospitals have no ability to negotiate reimbursement rates for government-paid services.
  • Commercial insurers or other purchasers of health care services usually negotiate discounts with health care facilities on behalf of the patients they represent.
  • Hospitals typically have policies that allow low-income persons to receive reduced-charge or free care.

Negotiations between hospitals and payers generally begin with the charge amount. While each facility's charge structure may vary in important ways, charges represent a consistent, though imperfect, way to compare health care costs.

Q: Why are charges for the same procedure higher at one hospital than another?

A: Charges Vs. Costs

The amount a facility bills for a patient's care is known as the charge. This is not the same as the actual cost or amount paid for the care. The amount collected by a health care facility for each service is almost always less than the amount billed. There are three common examples:

  • Government programs such as Medicare and Medicaid typically pay health care providers much less than the billed charge. These payments are determined by government agencies. Hospitals have no ability to negotiate reimbursement rates for government-paid services.
  • Commercial insurers or other purchasers of health care services usually negotiate discounts with health care facilities on behalf of the patients they represent.
  • Hospitals typically have policies that allow low-income persons to receive reduced-charge or free care.

Negotiations between hospitals and payers generally begin with the charge amount. While each facility's charge structure may vary in important ways, charges represent a consistent, though imperfect, way to compare health care costs.