Request a Good Faith Estimate
At Southcoast Health, we are committed to providing information to help you better understand the costs associated with your care. We recognize that sometimes your healthcare costs may not be covered by insurance, or you may have charges you did not anticipate.
We have provided you two options for you better understand the costs of our hospital facility-based services and procedures. Southcoast offers a good faith estimate or an estimator tool for hospital services.
Patients are entitled to receive estimates of expected charges from Southcoast Health when scheduling a health care appointment (or series of appointments), or any time upon request.
In the estimate, Southcoast Health will take into account the patient’s health insurance coverage (if known), and include information regarding the negotiated charge for the service, and total expected patient cost including any discounts available and facility fees that the patient is expected to owe. If Southcoast Health is unable to predict a specific amount in the estimate, Southcoast Health will disclose the maximum estimated amount and any corresponding facility fees.
You have the right to be informed if Southcoast Health is participating in your health insurance plan, and Southcoast Health can help you contact your insurer to obtain further information about your potential out-of-pocket costs.
To Obtain a Good Faith Estimate:
Contact Southcoast Health Patient Access team at 844-297-2952
In order to help Southcoast Health ensure your estimate is accurate, please be prepared to provide:
- Name
- Date of Birth
- Phone Number
- Insurance Coverage, including group number and ID if applicable
- Procedure/Treatment Information
- Other information Southcoast needs to be added
Southcoast Health will provide you with this estimate within two days of receiving your request and at least one day before your procedure. You have the right to dispute any health care bill that is at least $400 more than your estimate. Please retain a copy or picture of any estimate you receive.
Price Estimator Tool for Hospital Facility-Based Services
As required under the regulatory Price Estimates defined in January 2021, Southcoast Health offers a user-friendly tool to estimate costs associated with our numerous services and procedures.
Hospital facility-based services may be an inpatient or outpatient service or procedure performed at a Department of Public Health (DPH) licensed facility. Our hospital facility-based services include:
- The standard charges for at least 300 shoppable services or procedures
- 70 CMS-specified shoppable services or procedures
- 230 additional shoppable services or procedures
- Common services such as x-rays, joint replacements, imaging, laboratory tests, vaccinations, and more.
It is important to note, the estimates provided include only charges related to the hospital facility-based service. Providers and other physicians who provide services will bill you separately and are not captured in the estimate tool. These may include separate bills from:
- Anesthesiologists, radiologists, pathologists, and other specialists
- Independent lab, radiology, or emergency department services not directly associated with Southcoast Health
- Non-Southcoast Health providers who may be aiding in the service or procedure
WILL AN ESTIMATE VARY BASED ON THE LOCATION OF A SERVICE OR PROCEDURE?
No, Southcoast Hospitals Group facility-based services are standardized across all locations.
WHAT ARE MY OUT-OF-POCKET COSTS?
The best way to prepare for out-of-pocket charges is to contact your insurance company (their contact information is usually found on your insurance card). Your insurance company can discuss benefits, deductibles, co-pays, and other information to determine costs associated with your hospital facility-based services and procedures.
WHAT IS AN OUT-OF-POCKET COST?
The portion of your bill that is your responsibility is referred to as your out-of-pocket costs. Costs may vary from person to person and depends on individual insurance plans.
HOW IS MY HOSPITAL FACILITY-BASED SERVICE ESTIMATE DETERMINED?
The estimate tool will calculate your out-of-pocket cost based on the hospital’s chargemaster price, its claims history for providing that service, its contract terms with your insurer, and your benefit information and deductible status. It is important to note; you must provide benefits information and deductible status when using the tool. The estimate tool also estimates out-of-pocket costs for self-pay or non-insured patients.
HOW ACCURATE ARE ESTIMATES?
Estimates may vary, and an estimate is not a quote or guarantee. Many factors go into the final cost. Please see the estimate disclaimer to understand how charges may vary.
INFORMATION NEEDED FOR ESTIMATE
When requesting an estimate, you will need several specific details to calculate the most accurate estimate possible. These include the following:
- Insurance name (available on your insurance card)
- The name of the hospital facility-based service/procedure or CPT code (available from your provider).
- Insurance benefits information, including:
- Remaining deductible amount
- Coinsurance percentage
- Maximum-out-of-pocket amount
An important reminder, this estimate is for the hospital facility-based charges only. Our estimate does not include your physician, the anesthesiologist, or other specialist involved in your care.
HOW TO USE THE ESTIMATE TOOL
Search for a Service
- Search by category. For example, “knee”
or
- Enter a keyword, name, or CPT code.
- CPT codes are how procedures are categorized and ordered by your provider.
Browse by Category
Click on a category to see the list of services available in that category.
It is important to note that as we continue to build out this tool, there may be services or procedures not included in our current categories. If you have difficulty finding an estimate for a service not listed, please contact our Patient Access team at 844-297-2952.
Need further assistance?
The Southcoast Health Patient Access team can help you if your hospital service or procedure is not one of those listed on the online estimator tool or if you have other general questions about your cost estimate.
Connect with us by calling 844-297-2952.
Thank you for choosing Southcoast Health for your health care needs. We look forward to serving you.