Healthcare Costs and Charges

Adventist Health and its affiliated hospitals charge for items and services provided to its patients using national industry standard codes including approved CPT procedure and HCPCS codes. Adventist Health complies with all federal and state pricing transparency regulations by making available a list of current standard charges in a machine-readable format.

While Adventist Health’s California facilities are required to post certain charge information on the State of California, Office of State Health Planning Department (OSHPD) website, the state does not allow this information to be updated as rates change during the year. The most current information may be found at the link below.

View a list of current standard charges for your area.

Patient Benefit Advisor

In the following paragraphs, Adventist Health describes the general reimbursement methods used by type of payer. However, since the total payment amount or amount for which a patient could be responsible varies dramatically by payor, patient’s health plan or type of service provided, Adventist Health makes available patient benefit advisors who can provide estimates based on the unique circumstances of each patient and episode of care. Find a benefit advisor for your hospital.

Reimbursement For Medical Services

The charges listed at the links above generally have little to do with the actual amounts paid by patients and insurers. Normally, amounts paid are based on either the type of care provided to the patient, or the number of days a patient stays in the hospital.

Medicare and Medicaid payments are based on factors published by the government which may vary by region and hospital. Private insurance companies negotiate contracts with hospitals to make medical services available for their members. Services are then paid for at the agreed upon rates.

For patients without insurance coverage, hospital charges are discounted to the amounts generally paid by Medicare and Private insurance payers. These discounts are described by the Uninsured Discount Policy.

In addition to payment for hospital services, services provided by physicians are billed separately. These charges are common for emergency room visits, radiology tests or surgical services. Charges for physician services are usually not included in the hospital’s list of standard charges. Since these services are negotiated separately by each physician, patients need to contact their physician for more information about reimbursement and amounts for which the patient will be responsible.

Patient Responsibility Amounts

The portion of reimbursement for medical services for which the patient will be responsible also differs by type of insurance.

Patient responsibility amounts are established by Medicare for their enrollees. For inpatient stays, enrollees are currently responsible for $1,340 for inpatient stays of less than 60 days. Between 61 and 90 days, the enrollees are responsible for $335 per day. Beyond 90 days, patients will be responsible for $670 per day until “lifetime reserve days” are exhausted at which time they become responsible for all payments.

For outpatient services, Medicare enrollees have an annual deductible of $183. Once this has been met, Medicare enrollees are generally responsible for 20% of the Medicare payment.

Medicaid beneficiaries may have a small share of cost depending on their income level.
For patients covered under private insurance plans, patient responsibility amounts are not negotiated with the hospital, but are determined by terms of the plan purchased either through an employer or directly by the patient.

Financial Assistance

Adventist Health also makes available financial assistance for patients whose income meets criteria based on federal guidelines. View the income criteria and amounts of financial assistance.