Price Information and Transparency

Welcome to Washington Regional Medical Center, where your health and well-being are our top priorities.

Here at Washington Regional, we believe in transparency when it comes to your healthcare costs. In line with federal guidelines from the Centers for Medicare and Medicaid Services (CMS), we’re dedicated to providing you with clear information to help you navigate your healthcare journey confidently.

Understanding healthcare billing can be complex, especially with the multitude of insurance plans available. That’s why we encourage our valued patients to reach out directly to their insurance provider or connect with our financial services team for personalized estimates. Rest assured, we’re here to assist you every step of the way.

For those without insurance coverage, including Medicare or Medicaid, Washington Regional offers financial assistance options such as discounts or reductions on our standard charges.

As a token of our commitment to your well-being, we’ve compiled some helpful information to shed light on the intricacies of healthcare billing.

What’s not covered in our chargemaster and consumer driven services (shoppable services) list?

It’s important to note that charges for services rendered by the doctor or doctors overseeing your care at our hospital are not included. This means you may receive separate bills from both the hospital and the physicians involved in your treatment.

Here is a sample of some of the healthcare providers who might bill you separately:

Attending Physicians that may visit during your hospital stay
Emergency room physicians
Radiologists interpreting your imaging results
Other specialists your doctor may consult during your hospitalization
Pathologists reviewing your specimens

Additionally, certain laboratory testing may not be covered. We want to ensure that you are aware of all potential billing entities so you can plan accordingly and make informed decisions about your healthcare journey.

Price Transparency

At Washington Regional Medical Center, we aim to provide transparency regarding hospital charges to our valued patients. Through our chargemaster, you can access a detailed list of charges for services and items provided at our Plymouth NC Campus. This comprehensive list covers everything from tests and exams to room charges.

While we strive to offer this information in compliance with state and federal guidelines, we understand that it can be overwhelming and may not directly answer questions about actual costs or specific bills. We encourage you to learn more about our chargemaster to better understand how it functions.

It’s important to note that the amounts listed in our chargemaster are typically not what patients are billed. Instead, they are billed to insurance companies, Medicare, or Medicaid, which then apply their negotiated rates. For uninsured patients, our hospital offers discounts. Please contact our financial assistance team for any questions you may have.

Please be aware that while our hospital charges remain consistent for all patients, the actual amount billed and your financial responsibility may vary depending on the specific services provided during each visit and your insurance coverage. Additionally, charges for certain items like medications and supplies may fluctuate throughout the year, potentially resulting in discrepancies between the listed charges and your statement.

The details provided in our chargemaster represent a thorough compilation of charges for both inpatient and outpatient services or items offered at Washington Regional Medical Center. These charges were verified for accuracy as of January 31, 2023.

While our hospital upholds uniform charges for all patients, the final amount billed and your financial responsibility can differ significantly. This variance is influenced by the particular services rendered during each visit and the type of insurance coverage you possess. Additionally, fluctuations in charges for medications, supplies, and other factors throughout the year may result in disparities between the listed charges and what appears on your statement.

CHARGEMASTER DOWNLOAD:

chargemaster file

Note: Click link above to download our machine-readable file. File can be opened in Microsoft Excel (.csv)

FAQ:

Will the chargemaster file assist me in estimating my out-of-pocket expenses?

While the chargemaster file contains detailed information, it may not provide precise estimates for patients regarding their out-of-pocket costs. Your actual billing and expected payment, especially if you’re covered by health insurance, depend on the specifics of your insurance coverage and the contractual agreements between your insurance company and the hospital. For personalized assistance in understanding your costs, please don’t hesitate to reach out to our Financial Services Team at: 252-387-8885.

How Can I Access Further Details?

For additional information regarding our chargemaster, understanding your healthcare expenses, or our financial assistance policy, please reach out to our WRMC Financial Services Team at 252-387-8885 . We’re here to assist you.

Terminology explained:

DRG/MS-DRG:

DRG stands for Diagnosis-Related Group. It’s a system used by Medicare and some other health insurance providers to classify hospital cases into groups that are expected to have similar clinical characteristics and costs. This classification system is used for the purpose of payment, where hospitals receive a fixed amount of reimbursement for each case within a specific DRG category. MS-DRG stands for Medicare Severity-Diagnosis Related Group. It’s an extension of the DRG system used by Medicare to further classify cases based on severity of illness and resource utilization. MS-DRGs provide a more refined way of determining reimbursement rates by accounting for factors such as complications, comorbidities, and major complications or comorbidities (MCCs/CCs) that may impact the cost of care.

REIMBURSEMENT/PAYMENT:

Reimbursement denotes the funds a hospital collects for delivering healthcare services. These funds typically originate from three primary sources: government programs like Medicare and Medicaid, commercial insurance providers such as BCBS, Aetna, and Cigna, and direct payments from patients. Patient payments may encompass various out-of-pocket expenses such as co-pays, deductibles, coinsurance, or costs not covered by their insurance plan.

Charge/Hospital Billing:

The cost structure at hospitals encompasses a multitude of factors, including supplies, medication, medications, and the personalized care tailored to each patient’s needs. Hospitals are tasked with establishing fixed rates for many thousands of items, which are meticulously recorded and updated within the hospital’s billing system.