Pricing Information & Estimates

Price Transparency & Disclosure

The purpose of this policy and procedure is to provide information and guidance regarding the availability and disclosure of price information at CoxHealth Hospital Facilities. This policy documents how CoxHealth complies with the Affordable Care Act (ACA) Transparency requirement. Information about pricing of physician services can be obtained directly from the physicians’ office.

Policy

CoxHealth believes that in order for prices to be meaningful, a personalized price estimate is needed, and such estimates will be provided upon request and/or offered to the patient at the time of registration on certain scheduled services. Prices for a particular procedure or episode of care varies depending on the specific services provided as well as the degree of complexity and/or specific condition of the patient. Personalized price estimates are CoxHealth’s primary source of price information. To provide meaningful information to consumers, price estimates include, where applicable, facility charges, estimates of payer allowable and patient out-of-pocket responsibility.

Scope: All CoxHealth Hospital and Provider-Based Facility Services

Definitions

Price Transparency - The accessibility of the hospital’s standard price information
Disclosure - The act of making CoxHealth hospitals’ standard price information available to the public
Price Estimate - A personalized estimate of an individual’s scheduled or anticipated hospital medical service(s), which factors in the typical charges associated with the service(s), the estimated amount the payer will allow, and the estimated patient out-of-pocket expense

Contact Information

Patients may call, write, email or request a price estimate in person at the point of registration as set forth below. Financial counseling and pre-registration staff will provide the requested pricing estimates.

To request an estimate of hospital services
To request an estimate of hospital services Call (Cox Medical Centers Springfield, Branson and Monett)	417-348-8930
To request an estimate of hospital services Call (Cox Barton County Hospital)	417-681-5227
To request an estimate of hospital services Write	Cox Medical Center, P.O. Box 650, Attn: Financial Counselors, Branson, MO 65615
To request an estimate of hospital services Email	CMCB_DL_FinancialCounselors@coxhealth.com
To request an estimate of hospital services In person	Request information at the point of registration

To request an estimate of physician services
To request an estimate of physician services Call	417-269-4353
To request an estimate of physician services Write	Ferrell-Duncan Clinic, PO Box 9007, Attn: Financial Counselor, Springfield, MO 65808

To request an estimate of neurosurgery services
To request an estimate of neurosurgery services Call	417-631-0374

Media Requests
Media Requests Call CoxHealth Corporate Communications	417-269-4113

Price Estimation

Price estimation and insurance eligibility software is utilized to evaluate historical charging patterns, current pricing, payer allowables and the patient’s insurance plan benefits against the anticipated or scheduled service to be provided to the patient. The co-pay, deductibles and coinsurance are applied to the allowable to estimate the patient’s out-of-pocket responsibility.

The patient is provided with a verbal explanation of the price estimate. A consumer-friendly written summary of the estimate is mailed or offered to the patient in person.

General Price Information & Requests

Complete lists of all standard prices per facility are available at the links below. In addition, we have provided lists of the average standard prices per Diagnosis-Related Grouping (DRG), which are based on the standard prices charged in the previous fiscal year for each DRG averaged across all cases then inflated by the current year’s overall rate increase. These lists are in a machine-readable format to comply with federal requirements.

The total price for a particular procedure or episode of care varies depending on the specific services provided as well as the degree of complexity and/or specific condition of the patient. Patients’ out-of-pocket expense also varies depending on their insurance coverage and benefits.

The price lists will be updated at least annually. While most pricing changes occur in October, all prices are subject to change as needed. In particular, pricing for services that require the use of supplies and pharmaceuticals may change more frequently as these items are based on the cost to purchase.

Other general price requests may be referred to a financial counselor at the number and/or email indicated above in Section 1. Inquiries that do not request an estimate for a specified service(s), or that are made by the Media or other outside parties will be referred to CoxHealth Corporate Communications or the appropriate party for review including, without limitation: Revenue Cycle, Legal and Corporate Integrity Departments and CoxHealth Chief Financial Officer.

Please allow 30 days for a request to be processed.