Beth Israel Lahey Health Price Transparency

The Centers for Medicare and Medicaid Services (CMS) requires hospitals to provide clear, accessible pricing information about the items and services they provide in two ways:

1. Provide information about the rates negotiated with insurance companies for all services and items offered by our hospitals. This information is not an estimate of the costs that you are responsible for paying. The CMS-required hospital charge data files might not be the best tool for patients and families who are comparison shopping between hospitals and health systems for shoppable services. You can find our CMS-required hospital charge data in the treatment cost calculator. Please note: Because of the size of the files, you may need special computer software/speed to open the files.
2. Show shoppable services in a consumer-friendly way. CMS defines shoppable services as those that can be scheduled in advance. Hospitals are required to make available a minimum of 300 shoppable services, including a pre-set list of 72 procedures.

Beth Israel Lahey Health offers a consumer-friendly online calculator to estimate the cost of out-of-pocket expenses for common exams, procedures, and tests, including the 300 shoppable services. Patients, can access the estimates calculator by clicking here.

For more information about hospital costs, visit CompareCare, a website created by the Commonwealth for consumers to compare costs of medical procedures and quality metrics across Massachusetts.

As required by the federal government (Centers for Medicare and Medicaid Services), we publish information (comprehensive machine-readable files) about the rates negotiated with insurance companies as well as individual gross charge amounts for all services and items offered by our hospitals. These amounts are almost never billed to you or received as payment by a hospital. The amounts are billed to an insurance company, Medicare, or MassHealth. These payers then apply their reimbursement terms or contracted rates to the services billed which is why these rates are also not generally reflective of your out-of-pocket expenses. If you owe a co-payment, co-insurance, or deductible, these too are most often not based on chargemaster amounts, but are based on the payment terms determined by your insurer or government program.

The CMS-Required Charge Data File for the hospitals within Beth Israel Lahey Health do not include services provided by physicians and/or other providers who are not employed by the hospital. A partial list of the healthcare providers who may bill you separately include:

• Your personal physician and/or provider
• The surgeon who performs your procedure
• The anesthesiologist
• The radiologist who reads your x-rays or other imaging studies such as an MRI or CT Scan
• Other physicians and/or providers who may have been asked to provide a consultation during you time in the hospital

Yes, there is one list of charges used by the hospital. Your individual charges will vary for reasons including:

• Differences in the specific services received
• How long it takes to perform the service or how long it takes you to recover in the hospital
• Whether the service you receive is more or less difficult than expected
• The kinds of medication or supplies you require
• Whether you experience complications or require additional treatment

Yes, Beth Israel Lahey Health recognizes that not all patients have the resources to pay for care they need, and we are committed to providing assistance and financial counseling. If you have limited or no insurance coverage, you may qualify for help through MassHealth, Commonwealth Care or Health Safety Net. Check our financial assistance policy below for more information.

Certain physicians are not covered under our financial assistance policies. A financial counselor can provide more information.

When you get emergency care or are treated by an out-of-network provider at an in-network hospital, you are protected from balance billing (also called surprise billing). In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible. You have rights and protections against surprise medical bills.

• Balance/Surprise Billing Protection Notice
• Right to Receive a Good Faith Estimate of Expected Charges Notice