Price Transparency for UW Health Services

Getting Price Estimates for UW Health Services

 

You can create your own price estimates here, or by contacting UW Health's Priceline at (608) 263-1507.

 

You will be given a price estimate, not a price guarantee, as the final charges are based on a variety of factors related to the clinical service provided, the diagnoses associated with those services and supplies used. While it is possible to estimate these, it is not possible to precisely define these until after the service has been provided.

 

How does UW Health's prices compare to other Wisconsin facilities?

 

Wisconsin Act 146 seeks to make health care costs and charges clearer to consumers. It requires health care providers to disclose, upon request, certain charge and payment information for health care services, tests and procedures.

 

For comparative information on the quality of care at UW Hospitals and Clinics, please see the Wisconsin Collaborative for Healthcare Quality's website at www.wchq.org.

 

For comparative information on the pricing of care at UW Hospitals and Clinics, please see the WHA For Transparency website at www.wipricepoint.org

 

Cost and Quality Information for Health Care Consumers In Compliance Wisconsin Act 146 (pdf)

 

Pricing Transparency

 

UW Health believes generating an estimate using our Guest Estimate feature or through your Mychart login, will provide a better value in understanding your potential out of pocket expenses. This tool is found at https://mychart.uwhealth.org. If you have questions regarding your cost for a specific service, please contact UW Health Priceline at (608) 263-1507.  A financial counselor can review your specific information to provide you with an estimate and/or discuss any financial concerns you may have.

 

The Centers for Medicare and Medicaid Services (CMS) requires each hospital to post a list of their standard charges—a Charge Description Master (CDM)— in a machine-readable format and update the data at least annually. A standard charge means the regular rate established by the hospital for an item or service provided to a specific group of paying patients. For purposes of complying with the Hospital

Price Transparency Final Rule, this includes five types of standard charges: gross charge, discounted cash price, payor-specific negotiated charge, de-identified minimum negotiated charge, and de-identified maximum negotiated charge. CMS intended that this information would help patients with improved information regarding price transparency.

 

The CDM and the corresponding standard charges themselves may not provide the appropriate price transparency for the patient as a patient’s out-of-pocket cost is not determined by the standard charges of a hospital alone.  The out-of-pocket cost is driven primarily by:

  • Any copay, deductible, and/or coinsurance required by the patient’s benefit plan; and  
  • The negotiated charge that the patient’s insurance carrier will pay the hospital, which is generally less than the standard charges.
  • Any patient that is uninsured will pay the discounted cash price.

 

If you still wish to review the CDM, please understand the following:

  • The descriptions in the CDM may not be understandable to the layperson.
  • The inpatient total charge amount and reimbursement rates for many procedures is made up of many individual charge items from the CDM.
  • Due to variations in individual physician practice patterns, as well as individual patient differences and the potential for unforeseen complications, charges may vary based on the patient’s situation. Payer specific negotiated charges are sometimes not at the charge master item level and therefore we are unable to provide these amounts at this level of detail.

To view the standard charge listing for UW Health University Hospital, American Family Children’s Hospital, and UW Health at The American Center; click here.

 

Additional Resources

 

HealthCare Financial Management Consumer Guide

You can create your own price estimates