Billed Charges and the Expected Cost
Information on Billed Charges and the Expected Cost to the Patient
Questions: (559) 624-4100
Monday - Friday: 8 a.m. to 5 p.m.
Kaweah Delta understands there are many complexities with navigating health
care pricing and, in particular, out-of-pocket costs to our patients.
Our goal is for patients to understand what their out-of-pocket financial
responsibility is for their care at Kaweah Delta. It is important to note
that for the most part, billed charges do not reflect the actual price
a patient, or guarantor, will pay. For example, billed charges do not
take into account any contracted rates with insurance plans or discounts
a health care provider applies when a patient, or guarantor, pays in cash.
In order to accomplish this goal, we have established a direct phone number
for you to call and speak to a knowledgeable representative, available
8 a.m. to 5 p.m., Monday - Friday. Our friendly Patient Access representatives
will assess your individual financial coverage and explain what this means
to you and your estimated out-of-pocket financial responsibility.
Your specific financial responsibility will depend on many factors, including
any insurance plan(s), or coverage, you may have active on the date of service.
Your insurance policy is a contract between you and your insurance company.
You should be familiar with the terms of your healthcare plan. Most plans
do not provide 100% coverage for your hospital bill. You are responsible
for co-payments, coinsurance, deductibles, and other charges not covered
by your insurance plan. Most plans detail exclusions, services not covered,
and plan maximums - please refer to your insurance plan document for specific
details regarding what is covered and not covered under your insurance plan.
Here is what some of the frequently used insurance and billing terms mean:
The amount of money your insurance plan pays for the health care services
Billed Charges mean the total charges billed by a health care service provider.
It shows the gross billed or retail price of services and does not represent
the amount paid by the patient or the amount collected by the provider.
Kaweah Delta’s published charge master is not the actual amount you
will pay in financial obligation for any health care service because our
charge master contains higher amounts before applicable discounts or negotiated
rates are applied.
This is another word for a health care bill. It is sent to your insurance
plan, and lists out all of the services you received.
Some insurance plans cover a percentage of the costs of your care. For
example, if your plan has 10% coinsurance for a service that costs $50,
your insurance plan will pay $45 and you will pay $5.
A fixed amount paid by a patient for a covered service. Some insurance
plans cover certain types of care at a set rate - also called a copay.
For example, your plan may charge $25 per doctor visit or $50 for each
day a patient is an inpatient in the hospital.
A set amount you have to pay every year before your health insurance company
starts paying. For example, if your health care service costs $5,000 and
your plan’s annual deductible is $3,000, once you have paid that
$3,000, your insurance plan will pay all or part of the remaining $2,000
(depending on what type of coverage your plan has). Most insurance plans
have to cover some services (like check-ups) regardless of whether you
have met your annual deductible already or not.
This is a list of charges for health care services. Insurance plans publish
fee schedule lists representing the maximum charges (or prices) they will
reimburse for the same services. In many instances, the reimbursement
amount offered by insurance plans is less than what is charged by health
The amount that must be paid to the insurance plan to maintain the desired
insurance plan coverage.
Kaweah Delta’s average gross billed charges
HERE to Kaweah Delta’s standard billed charges for itemized services.
HERE to Kaweah Delta’s average gross billed charges by diagnostic-related
grouping (a.k.a. DRG). This list is a grouping of typical billed charges
used in an inpatient stay based on the diagnosis.
As noted above, it is our goal to help you - our valued patient - to better
understand any out-of-pocket financial responsibility you may have when
seeking health care services at Kaweah Delta. It will be our pleasure
to talk you through the process.
Please call Patient Access, 559-624-4100 and speak to a knowledgeable representative,
available 8am to 5pm, Monday - Friday.