Cost of Care: Frequently Asked Questions
Q. Why do you post your charges on your website?
A. The Centers for Medicare & Medicaid Services (CMS) have mandated that effective Jan. 1, 2021, all hospitals publish their charge masters in a consumer-friendly, machine-readable format to help patients understand their potential financial obligations for services received at a hospital.
Q. What is the charge master?
A. The charge master is the item list of retail charges that are billed by a facility. These retail prices incorporate room and board (for inpatients), clinic or treatment room, supplies, nursing care, equipment use, pharmaceuticals, nutritional services and any services performed by our technical staff and clinical staff. Actual charges for services depend upon services actually provided.
Q. What services are excluded from the charge master and other price transparency tools?
A. Physician services related to your hospital stay or visit are not included; they are billed separately. Doctors cannot be directly employed by a hospital, even if they work in a hospital. Therefore, you will receive a separate bill from any doctors who treated you during your stay or visit. This may include radiologists, anesthesiologists, pathologists, primary care physicians, hospitalists and others.
Q. I calculated my charges based on your online Charge Master, but UCI Health is billing me for more than I calculated. Why is there a difference?
A. Charges for services are based upon the clinical documentation of actual services performed. Resources used and tests ordered can vary from patient to patient.
Q. Can I get an exact pricing estimate?
A. We do our best to provide you with accurate estimated pricing. However, price estimates are not a guarantee of exact pricing because actual treatment received may differ from services quoted.
For example, your physician may order additional tests or services to address unforeseen medical complications or clinical needs.
Q. What happens if I have insurance?
A. UCI Health has contracted with many payers to establish reimbursement for services and will bill your insurance for all services provided by our hospital. Everyone is charged the same based on our Charge Description Master (CDM) retail pricing, but out-of-pocket expenses can vary by patient due to insurance plan benefits and coverage terms and conditions. Copayments, coinsurance or annual deductibles can be different by payer. In addition, UCI Health’s negotiated contract with your payer will impact your out-of-pocket expenses. We will do our best to accurately estimate your out-of-pocket expense based upon the insurance and services you have selected using the price estimate tool.
Q. What if I don’t have insurance?
A. UCI Health will assist you by screening for linkage to a government program. If you do not meet the criteria for application to a government program, UCI Health offers discounted cash packages to our uninsured and underinsured patients. Discounted cash packages are paid prior to services being rendered.
In addition, UCI Health offers financial assistance and interest-free payment plans. Please review our Financial Assistance guidelines. You may also contact our Shared Billing office at 833-353-7700 and select option 8 for assistance.
Q. Why am I being billed for facility and professional fees when I only saw the doctor?
A. UCI Health is an academic facility and has several facility licensed clinics. In California, hospitals generally are not allowed to employ physicians and therefore, services received at UCI Health-licensed clinics incur a facility charge for use of space, supplies, pharmaceuticals, treatment room (for procedures performed in the clinic), and a technical component for radiology, laboratory tests and biopsies. All hospitals in California with licensed clinics must bill separately for hospital services and physician services.
We strive to ensure your medical bills are accurate and easy to read and understand. If you have any questions, please contact us by phone, mail or message us via MyChart.
Service package: A service package includes all charges for a procedure. Two examples of service packages are colonoscopy and cardiac catheterization. They are also considered shoppable services.
Shoppable service: A shoppable service or procedure is one that can be scheduled by a healthcare consumer in advance. These are services for non-urgent situations that do not require immediate action or attention to the patient, allowing patients to price shop and schedule a service at a time that is convenient for them. Examples of common shoppable services include imaging and laboratory services, medical and surgical procedures, and outpatient clinical visits.
Discounted cash package: UCI Health offers discounted cash packages to our uninsured or underinsured patients. Patients also have the opportunity to waive billing their insurance and pay a cash package rate.