Determining Your Out-Of-Pocket Expenses
We know that paying for healthcare is a big concern for many. We are committed to providing you with as much information as possible regarding what you can expect in terms of cost, to help you make informed decisions about your care.
Your out-of-pocket costs depend on several factors including:
- The services or procedures you receive
- Your insurance provider
- Your specific health benefits policy including expenses such as your deductible, co-insurance, co-payment, and the limit of out-of-pocket expense requirements
- Your eligibility for financial assistance
Our price estimation tool can help you determine any out-of-pocket expenses for the most common services BEFORE you proceed with your care. For more detailed information regarding your estimated out-of-pocket expense for any procedure, we recommend that you contact one of our managers who can assist you further by providing a comprehensive estimate based on your insurance and benefits information and/or your personal financial situation. They can be reached at 914-378-6445 or by email firstname.lastname@example.org.
The Centers for Medicare & Medicaid Services’ Hospital Price Transparency Rule requires all hospitals to post a list of standard rates which represent the pricing information for all medical items and services that Montefiore provides.
The list of pricing information required by this rule does not necessarily reflect your out-of-pocket financial responsibility for your hospital visit. Why not? There are several reasons, but the most common are:
- We are required to list the price paid by your insurer – but this does NOT necessarily reflect your out of pocket cost.
- The medical services provided may vary from what was originally planned based on necessary circumstances at the time of your care
- You may also receive services from physicians or practitioners who are not employed by this hospital; their fees are not reflected in this listing.
It is also important for you to know that this price listing does not guarantee coverage, benefits, or payments.
Your financial liability may vary based on the particular terms of your insurance policy and the status of your health insurance benefits (i.e., deductibles, out of pocket maximum, co-insurance, and copays) at the time you receive care. Your eligibility, and the amount, of your coverage is ultimately determined by your health insurance provider.
We encourage you to contact one of our billing specialists to obtain more precise information regarding your potential financial liability.
You may view or download the standard rates file here (File Last Updated as of 05/16/23).
Information about Charges
For healthcare services provided at Montefiore, you may receive bills reflecting both professional charges from providers such as anesthesiologists, pathologists, oncologists or other specialists who have contributed to your care as well as hospital charges which include the cost of providing all other aspects of your care which are billed separately from professional services such as hospital stay, support staff, supplies, and medications. In addition, if your care was provided by a doctor who is affiliated with Montefiore, but also has a private practice, you may also receive separate bills from this doctor as is typical billing practice.
What are hospital and professional charges and how do they impact you?
Charges are the dollar amount a provider sets for services provided before negotiating any discounts. The charge is different from the amount paid. Patients covered by Medicare, Medicaid, Commercial insurance plans, and uninsured patients who qualify for financial assistance never pay full charges. For patients who do not qualify for financial assistance, but are uninsured, we also offer steeply discounted rates.
At Montefiore we are committed to helping people understand the best options available to pay for their medical care. Our staff can help you understand what is covered by your specific health insurance benefits policy, expenses such as deductibles, so-insurance, co-payment and out-of-pocket expense limits. In addition, if you do not have insurance, we can assist you with determining your eligibility for free or low-cost insurance, as well as governmental assistance. Our financial services counselors can also help assess if you may qualify for financial assistance. You can learn more here.
Participating Insurance Plans
A list of insurance plans participating with Montefiore is provided for you here. Please note that some providers who may be involved in your care may not participate in the same insurance plans covering care at Montefiore. Therefore, we recommend you check with the physician arranging for hospital services to determine if the physician participates in a plan that covers your care. A list of physicians who provide services at Montefiore facilities is available for you here.