CMMC Chargemaster

In compliance with the Centers for Medicare and Medicaid Services (CMS), Claiborne Memorial Medical Center (CMMC) is making available to the public a copy of its standard charges known as a "Charge Master." Before you search through this file to learn what it MAY cost to receive an item or service provided by CMMC, it is important to understand that what the hospital charges for a service IS NOT the same as what you or your insurance company may pay for a service. In fact, virtually no one pays the charges you will see listed. Charges are simply a tool that health care providers use to negotiate contracts with insurance companies, and to evaluate the financial impact of these negotiations on the financial health of the institution.

Download the CHARGEMASTER


HOW ARE CHARGES SET?

Charges are set by the hospital based on the total direct costs (professional fees, staffing, supplies, equipment) and indirect costs (administration, medical records, billing, housekeeping, maintenance, facility expenses, etc.) of providing the service. Often, charges are also compared to charges established by other hospitals and clinics in the region to help ensure they are comparable. Charges can be hard for patients to understand because they reflect:

  • the direct services the patient actually experiences,
  • ALL the things that happen behind the scene that make those services possible,
  • AND the cost of making those services available 24-hours-a-day, 7-days-a-week, 365-days-a-year.

  • WHAT DOES THE HOSPITAL ACTUALLY GET PAID?

    Claiborne Memorial Medical Center is seldom - if ever - paid the full amount of billed charges.

    The hospital negotiates payment rates with every major insurance company that provides coverage to residents in our community. As part of that negotiation, the insurance company typically establishes an "allowable" rate for each item or service, and then further establishes a discount from that "allowable" rate that they will pay, minus any deductibles, coinsurance and co-pays that the insurance company indicates are the patient's responsibility. This "allowable" rate typically falls well below hospital charges.

    If the insurance company refuses to contract with the hospital, or the hospital is unable to negotiate a satisfactory contract with the insurance company, Claiborne Memorial Medical Center may be considered "out-of-network" with that plan. The insurance company may then chose not to pay for the services you receive at an "out-of-network" hospital, increasing your out-of-pocket payments.

    It is likely that your insurance company has negotiated different payment rates with each hospital under contract.

    It is the patient's responsibility to contact your insurance company or agent to determine if CMMC is in network.

    WHAT IS THE IMPACT OF CHARGES ON DEDUCTIBLES, COINSURANCE AND COPAYMENTS?

    Deductibles vary by insurance company and reflect the plan you or your employer selected and the premium paid for that coverage. Lower deductible plans typically have higher monthly premiums, while higher deductible plans have lower monthly premiums. The deductible is the amount you will pay each calendar year before you receive full benefits from your insurance company.

    Established by your insurance company and plan, coinsurance is a percentage of the "allowable charge" that you will pay after you have reached your deductible. Also established by your insurance company or plan, co-pays are a flat fee you pay for a health care service. Co-pays can take effect either before or after your deductible has been met, and may not apply to all services. Information about your deductibles, coinsurance and copayments are available from your insurance company or employer.

    WHAT ABOUT MEDICAID?

    Medicaid pays all hospitals based on the same fee schedule. You can view the fee schedule or lookup a Medicaid fee online at: https://www.lamedicaid.com/provweb1/fee_schedules/feeschedulesindex.htm.

    QUESTIONS regarding your Louisiana Medicaid benefits should be directed to the state hotline at 888-544-7996 or you may visit the Louisiana Department of Health & Hospitals website https://www.lamedicaid.com.

    WHAT ABOUT MEDICARE OR MEDICARE ADVANTAGE PLANS?

    Medicare pays Claiborne Memorial Medical Center based on the actual cost of providing care to Medicare patients. If you have a supplemental plan or Medigap coverage, it may pay some or all of your deductible, coinsurance and co-pays.

    QUESTIONS regarding your Medicare benefits should be directed to 1-800-MEDICARE or http://www.mymedicare.gov.

    If you have enrolled in a "Medicare Advantage Plan" you no longer have traditional Medicare. These "Plans" are offered by private insurance companies and have different monthly premium, deductibles, coinsurance and co-pays. You may contact the CMMC Business Office at 318-927-2024 x209 to determine if CMMC is in network for your Medicare Advantage Plan.

    QUESTIONS regarding your Medicare Advantage Plan deductibles, coinsurance and copayments should be directed to your insurance company or agent.

    WHAT ABOUT PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE?

    As required by the Affordable Care Act (ACA), CMMC has a written financial assistance policy that includes eligibility criteria, the basis for calculating charges and the method for applying for financial assistance.

    QUESTIONS about CMMC payment options should be directed to the CMMC Scheduling Office at 318-927-2024 x217. You may contact our Financial Counselor at 318-927-2024 x241 to determine if you meet the criteria for financial assistance.

    QUESTIONS?

    If you have further questions about charges at Claiborne Memorial Medical Center, please contact the CMMC Business Office at 318-927-2024 x358.