What is the Hospital Charge Master?
A hospital charge master is a comprehensive list of all the billable services and items provided by a hospital. The charge master captures the costs of each procedure, service, supply, prescription drug, and diagnostic test provided at the hospital, as well as any fees associated with services, such as equipment fees and room charges. Because hospitals operate 24 hours a day, seven days a week, a charge master can contain thousands of services and related charges.
Charge master amounts are almost never billed to a patient or received as payment by a hospital. The charge master amounts are billed to an insurance company, Medicare, or MassHealth. These payers then apply their reimbursement terms or contracted rates to the services that are billed. If a patient co-payment, co-insurance, or deductible is owed, these too are most often not based on charge master amounts but rather the payment terms determined by the insurer or government program.
In situations where a patient does not have insurance, patients may be eligible for free or reduced cost of health care services through various state public assistance programs as well as the hospital financial assistance programs (including but not limited to MassHealth, the premium assistance payment program operated by the Health Connector, the Children’s Medical Security Program, the Health Safety Net, and Medical Hardship), Such programs are intended to assist low-income patients taking into account each individual’s ability to contribute to the cost of his or her care. For those individuals that are uninsured or underinsured, the hospital will, when requested, help them with applying for either coverage through public assistance programs or hospital financial assistance programs that may cover all or some of their unpaid hospital bills. You can find more information on our financial assistance policies or speak to a financial counselor at (each hospital can customize).
What is Not Included in the Charge master list?
The hospital’s charge master may not include charges for services provided by the doctors who treat you while you are at the hospital. You may receive separate bills from the hospital and the doctors involved in your care.
The following provides a list of providers who may send a separate bill for any services provided in the hospital:
- Your personal doctor, if he/she sees you in the hospital;
- The surgeon who performs your procedure;
- The anesthesiologist who works with the surgeon;
- The radiologist who reads your x-rays or other imaging; and/or
- Other doctors who may be consulted by your doctor during your time in the hospital.
Are Charges the Same for Every Patient?
The list of charges is the same for all patients. However, the total charges for an individual patient often vary from one patient to another for a number of reasons, including but not limited to:
- How long it takes to perform the service or how long it takes you to recover in the hospital;
- Whether the service or procedure you receive is more or less difficult than expected;
- What kinds of medication you require;
- Whether you experience complications and need additional treatment; and/or
- Other health conditions you may have that may affect your care.
As mentioned above, charge master amounts are almost never billed to a patient or received as payment by a hospital.
Where Can I Find More Information about hospital costs?
If you would like more information about what your care might cost you or the hospitals’ financial assistance policy, please contact one of our Financial Counselors at 781-453-3070 or 781-453-6048.
Your health plan can also help you to understand your insurance coverage, which charges will be covered, how much you will be billed, information on deductibles and your expected out-of-pocket responsibility.
MASSACHUSETTS TRANSPARENCY WEBSITE
Through the Center for Health Information Analysis (CHIA), the state has created a website, CompareCare (https://www.masscomparecare.gov/about), for consumers to compare costs of medical procedures across the Commonwealth. CompareCare also includes quality metrics where available. Regarding the cost quotes, the CHIA website provides an estimate based on amounts paid to health care providers in previous years. To find out what your specific out of pocket costs will be, contact your health plan