Price Transparency

To improve price transparency, all U.S. hospitals and health systems are required to provide lists of standard hospital charges — also called a chargemaster — so patients can compare prices across hospitals. Here are a few considerations to keep in mind as you view the list of standard charges:

• These charges are rarely the price that patients pay. The chargemaster lists the dollar amount set for each service before insurance contract/benefit plan discounts or self-pay discounts are applied, so the price patients pay tends to be less than the standard charge.
• Hospital charges differ from patient to patient for the same service depending on variations in treatment.
• Patients who are eligible for financial assistance also receive additional discounts.
• Items included in a charge vary across hospital systems. For example, what is included in one hospital’s charge for room and board may differ from another hospital’s charge — some hospitals bundle services together into a single charge that others may list separately.
• Looking at various hospital charges does not provide any indication of the quality of service and outcomes.

Douglas Gardens Hospital can help you obtain basic information regarding your cost of care for common medical services we provide at our facility. Use our tools below to estimate your out-of-pocket expenses to assist you in making informed health care decisions.

Please note that estimates are based on the insurance carrier and plan you have enrolled in. The benefits provided by your specific insurance plan will have an impact on the amount that you may owe. To obtain the most reliable out-of-pocket fee for a service at our hospital, it is important to speak with your insurance company. They will be able to assist you with information regarding deductibles, copayment and coinsurance related to the services received and in accordance with your insurance policy. 

Your individual expenses may vary based on pre-existing health conditions, the severity of your illness and the actual procedure performed. Estimates are not a quote or guarantee.

To help you better understand the costs of your medical care and assist you in planning ahead for medical expenses, these are the average rates for services provided at this hospital. These rates do not reflect your personal financial responsibility. Actual cost to the insurer and/or patient is determined by several factors and are not in the exclusive control of Miami Jewish Health, including, but not limited to:

1. The payment plans negotiated with individual health insurers, which may include commercial health insurance, automobile insurance, workers’ compensation insurance, or government health insurance coverage, e.g., such as Medicare, Medicaid, or Veterans Administration, etc.
2. The patient’s level of coverage, particular insurance plan (e.g., HMO, PPO, etc.), network participation status of each provider, and the patient’s currently outstanding benefits within the patient’s plan benefit package, including co-pays, co-insurance, remaining deductible, and out-of-pocket (OOP) amount.
3. The most appropriate services as determined by the patient’s treating and/or referring physician(s) at the time they receive the services may be substantially different than the anticipated medical need prior to provision of the medical treatment or services.
4. Although average cost is available through Miami Jewish Health, the nature of healthcare, including the factors described above, dictates that the appropriate level of care, and thus patient OOP cost of that care, frequently cannot be accurately determined until the care has been provided.
5. Patients with no insurance coverage can be eligible for a discount off the posted charges at Miami Jewish Health; however, additional financial assistance may be available to further lower an uninsured patient’s actual OOP expenses and to not exceed Medicare reimbursement.
6. Patients with or without government or commercial insurance should contact the hospital before a procedure to ensure the most accurate estimation of cost and/or patient responsibility.

The following charge information is based on historical data and is an average of charges for the service without complications. This set of charges does not include all physician fees. Your physician may find it necessary to perform more, fewer, or different procedures at the time of service, your final bill will include charges for the actual services provided to you. For questions about your financial obligation, we encourage you to contact your insurance company to verify the details of your coverage.

These estimated costs are only for the facility portion of a patient’s bill and do not include professional fees charged by physicians and other health care providers. You may receive a separate bill from the physicians or other health care providers.

Be aware that a single line-item charge may not represent a complete medical service; in general, multiple charge line items are necessary to represent all components of a service (e.g., procedure(s), supplies, and drugs).

The information provided to you is only an estimate and is based on your general insurance plan and the specific procedure listed. If the procedure is covered, the insurance company decides the amount you are responsible for paying. Specific information on what your deductible, coinsurance or copay will be, and whether a procedure is covered, can be provided by contacting your insurance company. Be sure to provide as much information as possible about the specific service or procedure, along with the Physician or Specialist’s name to receive a more accurate total cost. If your doctor’s office can provide you with the procedure codes or CPT codes, a more accurate estimate can be provided. Should you need additional assistance, please contact us at 305.754.1562.

Government agencies have other tools for exploring the quality and costs of health care facilities in Florida. However, the complexity of health care and negotiated payer rates means that the information in these tools may not necessarily reflect the actual cost for an individual patient, as it does not consider deductibles, co-pays or insurance coverage.

When you get care at an out-of-network facility, or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from “balance billing” (sometimes called “surprise billing”). In these cases, you should not be charged more than your plan’s copayments, coinsurance and/or deductible. For more information about your rights, visit the Centers for Medicare & Medicaid Services (CMS) website at the link below. If you think you have been wrongly billed, contact us at 305.751.3032.