Defining Price Transparency at Hennepin Healthcare

Definitions

Bundled Charges/Services: Charges that are grouped together, including multiple services. For example, a knee replacement will include the facility fee (hospital stay), anesthesiology charges, physician fee, pre-operative clearance, and supplies.

Claim (insurance): A formal request for reimbursement to an insurance company for medical services. A claim can make up several charges, this is the bill we send to the insurance company at negotiated rates.

Copay: A fixed out of pocket amount set by the insurance plan which is paid by the insured party, usually prior to a visit.

Coinsurance: An out of pocket percentage set by the insurance plan where the percentage of the claim is paid by the insured party.

CPT: Current Procedural Terminology (CPT) is a medical coding set used to identify/categorize medical, surgical and diagnostic procedures.

Deductible: An amount of money set by an insurance plan that must be paid by the insured party before insurance benefits will start paying on claims.

De-identified minimum negotiated rate: The lowest negotiated charge rate.

De-identified maximum negotiated rate: The highest negotiated charge rate.

Discounted cash price: The discounted amount charged to self pay patients.

Estimate: An approximation of the cost of healthcare services.

Facility Fee: The price the hospital sets for its portion of services. This could include certain supplies, room use, utilities, equipment, ancillary staff, and does not include professional provider charges.

Gross Charges: The list price. Contractual insurance rates or discounts are not included in this amount.

Guarantor: The person or party responsible for payment of services.

Hospital-Based Fee: the nationally-recognized billing process for services rendered in a hospital outpatient clinic or location. The location does not need to be at a hospital location.

Hospital-Based Location: Hospital-based care is care provided at a location that is clinically integrated with a hospital. This includes any of the clinics located on the downtown Hennepin Healthcare campus. Insurance may pay differently for services in these locations as opposed to a Freestanding Location such as: BeWell Clinic, North Loop Clinic, Richfield Clinic, Golden Valley Clinic, Saint Anthony Village Clinic.

Facility Fee: The price the hospital sets for its services.

Fee Schedule: A list of set fees for gross charges.

Freestanding Location: Locations not licensed as Hospital Based. This includes Hennepin Healthcare’s BeWell, North Loop, Richfield, Golden Valley, and Saint Anthony clinics.

Net Charges: The amount charged for services including contractual insurance rates or discounts. This is the amount seen on a claim or statement.

Non-Covered Services: Services not covered or paid for by insurance.

Out of Pocket Cost: The guarantor or insured parties expenses that are not covered by insurance. This includes the deductible, copays, coinsurance and any costs for non-covered services.

Payer-specific negotiated charge: charges that the hospital has negotiated with third-party payers for an item or service.

Physician Fee: The charge for a provider’s professional services.

Prior Authorization: An insurance company’s pre-service approval that they will help pay for authorized services.

Provider: The physician or other advanced practitioners who provide professional services to the patient.

Statement: Otherwise known as a bill. This is what is sent to a guarantor for any outstanding balance.