Colorado Hospital Price Report
The Colorado Hospital Price Report is a joint project of the Colorado Hospital Association and the Colorado Department of Regulatory Agencies, Division of Insurance. This website gives consumers and purchasers of health care services more information about average hospital charges and average reimbursement rates paid by insurance companies or health maintenance organizations. The report includes the 25 most common inpatient medical conditions and surgical procedures performed by hospitals.
Information About Pricing
The pricing information displayed here is representative of hospitals charges. If you have insurance, you will also be interested in the amount you will be responsible for – coinsurance (the amount of covered charges you are responsible for) and deductibles (the amount you must pay before the insurance company begins to pay). The actual charges on the statement you receive from the hospital will vary from the charges reported here. And what you actually will be responsible for paying will depend on your insurance policy and factors such as whether you have satisfied your insurance plan’s deductible, the amount of charges your plan does not cover, etc. If you do not have insurance, contact the hospital and ask them about their payment policies. Hospitals have charity care policies for patients who qualify.
The information presented here should be considered a starting point when comparing the cost of care between hospitals.
Here are some other things to remember:
- Physician charges are not included. You will receive a separate bill from your personal physician, and may receive a bill from a radiologist if you had x-rays or other radiology procedures, or from a pathologist if you had surgery or other lab tests performed, or from the Emergency Department physician if you were treated in the Emergency Department. Your surgeon and anesthesiologist will also send you a separate bill. Those charges are not included in the information displayed on this web site.
- Practice decisions vary from physician to physician, and collectively may explain some differences in charges and outcomes across facilities.
- Severity of illness and intensity of care may vary. Patients within the same diagnosis or procedure category may need very different levels of service and staff attention, causing a variation in charges.
- Current charges and outcomes may be different than those displayed here. The information presented is a snapshot of the data from the most recently available 12-month time period.
- Some reasons why charges may differ among facilities
- The equipment facilities use to provide services differs in age and frequency of use and may impact the charges of the hospital.
- Salary scales may differ by region and are typically higher in urban areas than in rural areas.
- Shortages of nurses and other medical personnel may affect regions differently. Where shortages are more severe, staffing costs, and, therefore charges, may be higher.
- Facilities differ in their approach to pricing based on operational costs. Some facilities try to spread the cost of all services and equipment among all patients. Others establish charges for specific services based on the cost to provide each specific service. Some facilities may provide certain services at a loss while other facility operations subsidize the losses. Any of these situations can result in significantly different charges among hospitals for a given type of service.
- Charges shown are the facility’s billed charges. Patients rarely are required to pay the full charges. Actual amounts paid are usually less.
The information shown here is based on Diagnosis Related Groups (DRGs). A DRG is a grouping of diagnoses which represent similar, but not the same, diseases, and the resources provided to care for patients with similar diseases. For example, there is more than one DRG for pneumonia; that is, a patient may group into a different pneumonia DRG depending on the type and severity of the pneumonia and the resources necessary to treat it.
SPECIAL NOTE: Medicaid Newborns are not included in this report, due to claims reporting process.
Talk to Your Doctor and Hospital
Well-informed patients, who actively participate in their medical care, seem to do better than more passive patients. Ask questions about your diagnosis and proposed medical care; written information may be available. If the terms are too technical, ask what they mean. Clear information will help you more successfully follow your doctor’s advice! This report is one tool to help you be a more active participant in the health care system; use it as a guide.
- Ask your physician which Diagnosis Related Group (DRG) category might be comparable to your condition.
- Review the number of patients treated at each hospital, the average length of stay and the average charges foreach of the severity categories. Check the inpatient quality indicators (www.cohospitalquality.org) if they are related to your condition or proposed procedure.
- Ask your physician and hospital (start with a patient representative or admissions counselor) how your condition and health status might affect costs, procedures, and length of stay.
- Ask your insurance company what is covered under your plan and what you will be expected to pay out-of-pocket for the proposed medical care. If you are concerned about your ability to pay, talk to a financial counselor at the hospital prior to admission if possible.
Here are some questions to ask when your doctor recommends tests, surgery or other procedures:
- What operation, treatment, or tests are being recommended? Why?
- What are benefits, risks and alternatives? What could happen if it is not done?
- How many of these cases has the hospital staff cared for or the physician treated?
- Will the outcome of a test affect treatment?
- How soon does an operation need to be done?
- What are the qualifications of the surgeon, anesthesiologist or other key health care providers who will be involved?
- Can you receive the care as an outpatient without staying overnight in a hospital?
- How long will recovery take? How limited will activity be during recovery?
- What kind of pain will there be after surgery? How will it be managed?
- What are the charges and fees?
- What additional charges may be incurred? (For example, will there be a bill from a laboratory or a medical specialist to read an x-ray or other test?) Will there be other consulting specialists?
- Will Medicare and/or other insurance cover charges? Will the physician accept the insurance payment in full? Do the physicians accept the same insurance as the hospital? (They may NOT.)
- Is home health care an option?
Frequently Asked Questions About Hospital Bills
Who do I talk to if I have a question about my bill?
Your billing statement may contain a phone number and name of the person to call if you have questions; if not, call the hospital’s main phone number and tell them you have a question about your billing statement. They will transfer you to the appropriate department.
I do not have insurance but need hospital care. What should I do?
Most hospitals have policies and procedures to help people who do not have insurance. These are sometimes referred to as ‘charity care policies.’ It is best to call the hospital prior to your admission to discuss options with them. If it is an emergency and you do not have time to talk with them before you seek hospital care, ask to talk with someone in the business office about your ability to pay as soon as you can during your hospital stay.
Why did I receive more than one bill for my hospital stay?
In addition to the billing statement from the hospital, you may receive a bill from physicians who were involved in your care, such as your surgeon, anesthesiologist, radiologist or pathologist. If you were taken to the hospital by ambulance, you may also receive a bill from them.
Why do hospital charges tend to be higher than the charges from a physician’s clinic?
In addition to being available 24/7/365, hospitals operate a number of departments that are both expensive and that generate little or no revenue. Departments such as the Intensive Care Unit and the Emergency Department require equipment, technology and highly trained staff to support their mission to provide life saving procedures and services to all who present to their hospital regardless of ones ability to afford the care they receive. Other supporting departments such as maintenance, environmental services, medical records, etc. also serve as key resources for providing quality patient care and yet do not generate revenue. Additionally, the higher level of care a hospital can provide to patients makes it nearly impossible to accurately compare hospital charges to those charges of a physician’s clinic. Hospitals also provide, in large part, charity care for those who are uninsured or underinsured as well as community outreach programming in support of their mission as a not-for-profit organization.
What is the difference between an out-of-network provider and an in-network provider?
Your insurance company negotiates contracts with hospitals and physicians to provide services to their clients at reduced prices. If a hospital or a physician chooses to contract with the insurance company, they are considered an in-network provider and your insurance company has negotiated a discount with the hospital or physician. An out-of-network provider is defined as a hospital or physician who has chosen not to offer a discount to the insurance company. If you choose to use an out-of-network provider, generally the out-of-pocket cost to the individual is higher than from using an in-network provider because the insurance company will not receive a discount from the hospital or the physician and the individual may be financially responsible for the difference.
For general questions about health care, refer to these sites:
- Agency for Healthcare Research & Quality www.AHRQ.gov
- American Hospital Association www.aha.org
- The Joint Commission www.JointCommission.org
- The Colorado Hospital Association www.cha.com
- Medicare www.Medicare.gov
- The National Institutes of Health www.NIH.gov
- The Institute of Medicine www.IOM.gov
- The National Library of Medicine www.NLM.nih.gov
- The National Patient Safety Foundation www.Npsf.org
- The Centers for Disease Control and Prevention www.CDC.gov
- The US Food & Drug Administration www.fda.gov/consumer
- Medicare’s Hospital Compare www.hospitalcompare.hhs.gov