Price Transparency Statement

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  • Price Transparency Statement

    Larkin Health Systems

    Price Transparency statement

    1. Services may be provided in the hospital by the facility as well as by other health care practitioners who may separately bill the patient;

    2. Health care practitioners who provide services in the hospital may or may not participate with the same health insurers or health maintenance organizations as the hospital;

    3. Prospective patients should contact the health care practitioner who will provide services in the hospital to determine which health insurers and health maintenance organizations the practitioner participates in as a network provider or preferred provider.

    Please refer to our physician directory under Find a Doctor Link.

     

    For Your Information…

    Our hospital is pleased to provide information to consumers related to the financial side of your healthcare needs.

     

    Here at this site, our patients can find out about:

    Obtaining a pricing estimate for our most frequently used healthcare services

    Payment options and alternatives available to patients without healthcare coverage

    Contact information to call us directly for a pricing estimate

    Paying your outstanding hospital bill online

    Other bills you might receive for services besides your hospital bill

    How our billing process works

     

    Price Estimate

    The pricing information provided is the best estimate based on the information we currently have available at the time of the request and is not a guarantee of what the patient will be charged.

    Please understand that in many cases it is impossible to predict the final charges that will result from your services, as there are many variables involved in the actual services, such as the length of time spent in surgery or recovery, specific equipment used, supplies and medications required, additional tests ordered by the physician, or any unusual special care or unexpected conditions or complications that may occur during the course of service.

     

    Florida Price Transparency

    On July 1, 2016, two bills related to health care price transparency became law in Florida. House Bill (HB) 1175 sets forth new and expanded requirements for hospital websites. The bill also requires the Agency for Health Care Administration (AHCA) to contract with a vendor to create a database using claims payment data submitted from health plans. HB 221 was developed to address “surprise bills,” which may occur when patients go to a hospital in their health plan’s network and are treated by an “out-of-network” provider. In this type of scenario, patients are subject to out-of-pocket fees. HB 221 requires hospitals, providers and health plans to post information about health plan network participation on their websites.

    In accordance with section 395.301, F.S., Hospitals are required to provide a link to the AHCA price transparency site, FloridaHealthPricing website (https://pricing.floridahealthfinder.gov), which shows average payments for over 200 service bundles. The service bundles include all components of care, including physician, ancillary and hospital payments. The average payment data is based on claims data submitted on non-Medicare and non-Medicaid member health care encounters by health plans.
    a)The service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services and that actual costs will be based on services actually provided to the patient;
    b) Patients have a right to request a personalized estimate from the hospital;
    c) Patients should contact the health care providers anticipated to provide services to the patient while in the hospital to obtain a personalized estimate of their costs, their billing practices and whether they participate in the patient’s health plan. 

    The service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services and that actual costs will be based on services actually provided to the patient;

    On November 27, 2019, the Centers for Medicare & Medicaid Services (CMS) passed a final rule that requires hospitals to publish data elements for items and services they provide. These data elements include the corresponding gross charges, payer-specific negotiated charge, de-identified minimum negotiated charge, de-identified maximum negotiated charge, and discounted cash price.

    Larkin Community Hospital has partnered with Craneware to meet CMS’s Price Transparency Final rule. To learn more about the Final Rule Click Here.

    To view our facilities Chargemasters, Standard Charges, and Shoppable Services please click the links below. 

    Larkin Community Hospital South Miami Campus

    Larkin Community Hospital – South Miami Campus (Consumer-Friendly Platform)

    Larkin Community Hospital Palm Springs Campus

    Larkin Community Hospital – Palm Springs Campus (Consumer-Friendly Platform)

    Larkin Community Hospital Behavioral Health Services

    Larkin Community Hospital Behavioral Health Services (Consumer-Friendly Platform)

    This website is designed primarily as a resource for you to obtain pricing estimates for our most frequently utilized hospital services.

    We hope that through this and the other information we provide here, you can make more informed choices about your healthcare and have a better understanding of your financial obligations when you visit our facility.

     

    Insured Patients

    Obtaining an Estimate

    In order to provide insured patients with the most accurate estimate based on your specific plan coverage and prospective services, please contact our Admitting Department at and one of our Financial Representatives will be happy to assist you.

    Prior To Your Call

    Prior to your call, it is important that you contact your insurance company to ensure that the services required are “covered services”. In the event that they are not a covered service under your plan, please refer back to our Uninsured information.

    You will also need to contact your physician’s office to get the specific diagnosis or procedure description.

    When you call our Admitting Department, please have the following information available, so that we can provide you with the most accurate estimate possible:

    Description of services needed – we will need to know as much information as possible about the specific services as described by your physician.

    Type of Services needed – we need to know if you will be admitted to the hospital as an inpatient overnight, or if you are expected to be treated on an outpatient basis.

    Physician/Specialist Name – example, if you are having surgery, we will want to know the surgeon’s name.

    Your Insurance Card – please have your card available so that if needed, we can get the following information from you: name of insurance company, type of policy (e.g. HMO, PPO, POS, Indemnity), policy holder’s name, group name and number, policy number, insurance company phone number.

    Policyholder’s Personal Information – it is possible that the insurance company will want us to verify the Social Security Number and date of birth of the person who is named as the primary insurance policyholder.

    During your call, we will attempt to verify your specific insurance benefits to provide the most accurate representation of your estimated financial obligation based on your specific coverage.

     

    Uninsured (Self-Pay) or Underinsured Patients

    You may be considered underinsured if you have a:

    High deductible

    High out-of-pocket maximum requirement

    Limited benefit plan(s)

    Uninsured discount

    Larkin Community Hospital’s Uninsured Discount Policy will supplement the Larkin Hospital Charitable Care and Financial Assistance Policy, which provides financial assistance.

    All Larkin Hospital sites will offer discounted prices to qualified uninsured patients for medically necessary care.

    Eligibility is contingent upon patient cooperation with efforts to apply for available Medicaid, Medicare or other Medical Assistance programs.

    The uninsured discount will apply to medically necessary inpatient and outpatient services for patients residing in the United States. The discount will not be offered to international patients or for cosmetic or elective procedures that are not medically necessary.

     

    Financial assistance

    In order to apply for financial assistance, patients will be required to apply for their state medical assistance (Medicaid) plan.

    Please know that the differences of these rates do not apply to your deductible or out-of-pocket maximum. Before your insurance pays, you will owe your co-insurance, copay, and difference between the rates.

     

    Resources: Florida Medicaid Assistance (Medicaid)

     

    Larkin Community Hospital is able to offer discounted pricing for patients without healthcare insurance (the “uninsured”) for all elective non-emergency,  pre-scheduled services – and for patients who do not qualify for our Financial Assistance Program.

    Our Admitting Department is able to provide you with detailed pricing information based on the specific service ordered by your physician. Our prices are based on good faith estimates and on our historical pricing experience for the specific services being provided. The Self Pay pricing estimates may include some hospital-based physician fees such as an anesthesiologist, pathologist, radiologist, and EKG reader. The Admitting Department will outline the actual included physician fees and services at the time of the quote.

    Prior to Your Call or E-mail

    Prior to contacting the Admitting Department, you will need to have the following information at hand so we can provide you with the best-estimated price quote:

    A description of services is needed. We will need you to provide as much information as possible about the specific services described by your physician. For estimated surgical quotes, you may be asked to provide us with the specific CPT Procedure code which is a five-digit numerical procedure code and can be obtained from your physician. This code will help in determining the procedure being performed and the estimated pricing quote.

    Physician/Specialist Name providing or ordering the services

    Date of Service if already scheduled

    What is TYPICALLY INCLUDED in the Discounted Self Pay Pricing quote?
    Estimated pricing quotes include your hospital-related charges such as room charges, nursing care, supplies and medication used during your visit for the specific service ordered and may* include some hospital-based physician fees such as an anesthesiologist, pathologist, radiologist, and EKG reader.

    The price quote is not a guarantee since the services may vary from the services you receive due to treatment decisions and/or unforeseen circumstances or additional test/services ordered by your physician and variation in the clinical needs of each patient.

    You will be expected to pay, upon arrival, the full amount of the Self Pay discounted price prior to the scheduled services being rendered and all monies must be in U.S. dollars. Methods of payment accepted at all Westchester General Hospital Facilities are American Express, Discover, MasterCard, Visa, cash, check or money order.

     

    Managed Care Accepted

    Refer to the list under Patients & Visitors, Accepted Insurances

     

    Your Hospital Bill

    This is how our billing process usually works. A claim will be sent to your insurance company shortly after your services are complete.

    After your insurance company receives the claim, the insurance company may contact you for additional information. Please respond to your insurance company’s questions as quickly as possible so their payment to us is not delayed.

    It usually takes 30 – 45 days for your insurance company to pay your claim. After your insurance company pays us, we will provide you with information about any amount you may still owe.

    Please keep in mind that your policy is a binder between you and your insurance company. If you did not follow your insurance plan’s terms, they may not pay for all or part of your care.

    Patient Account Services can assist you with questions or concerns regarding billing and answer general insurance questions.

     

    Charitable Care and Financial Assistance at Larkin Hospital

    It is the policy of Larkin Community Hospital to provide charity care to persons who have healthcare needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay, for medically necessary care based on their individual financial situation. Consistent with its mission to deliver compassionate, high quality, affordable healthcare services and to advocate for those who are poor and disenfranchised, Larkin Community Hospital strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. Larkin Community Hospital will provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility for financial assistance or for government assistance.

    Larkin Hospital seeks to provide support for those unable to pay for medically necessary care. Services include:

    Using fair and consistent billing and collection practices, including charitable care and financial assistance policies and a standard application process

    Providing extended payment plan options and medically necessary services at reduced rates or at no cost for patients eligible for financial assistance

    Providing emergency care, regardless of ability to pay

    Larkin Hospital determines the need for financial assistance by reviewing the medically necessary services requested by the referring provider; any care previously provided; available insurance coverage or other sources of payment; and an applicant’s financial profile. This method allows for a fair and accurate way to assist patients who are experiencing financial hardship.

    Required financial information may include annual household income, applicable assets, household size, and confirmation of application for all sources of coverage, including Medicaid, if eligible. International patients are not generally eligible for financial assistance.

    If you’re experiencing financial hardship, please contact Patient Account Services to discuss options such as a payment plan or financial assistance. You may visit our offices in any of the following locations:

     

    Patient Account Offices

    South Miami Campus

    5996 SW 70th Street

    South Miami, FL 33143

    Call 305-284-7610 Monday through Friday, 8:00 AM to 4:30 PM. Eastern-time.

    Palm Spring Campus

    1475 W 49th Place

    Hialeah, FL 33012

    Call 305-824-4810 Monday through Friday, 8:00 AM to 5:00 PM. Eastern-time.