Your Rights and Protections Against Surprise Medical Bills
The Centers for Medicare and Medicaid Services (CMS) and the Affordable Care Act (section 2718(e) of the Public Health Service Act) requires hospitals to publish a machine-readable list of their standard charges. The hospital's charge master, as this list is commonly known, is a comprehensive listing of the standard prices established by the hospital for individual services and supplies and may be accessed below. The charge master should not be used to estimate a patient's actual cost of care. Our hospital has a tool to assist with acquiring an estimate which can be accessed below or you may also call the Registration Department at 361-798-3671.
There are several things you should know when you are determining your financial responsibility for your hospital services.
For patients with health insurance through your employer, individual insurance marketplace or the healthcare exchanges:
Commercial insurers negotiate rates with hospitals on behalf of their members. The rates vary among insurers.
Several factors can affect the amount a patient owes to a hospital, including the type of plan you have, the amount your insurance benefits require you to pay for co-pays, deductibles and co-insurance.
Generally, the amount you pay will be less if your hospital and physicians are in-network with your health plan.
Be sure to review your benefits plan to understand all of the factors affecting your financial responsibility.
For patients with Medicare & Medicaid:
The government determines how much it will pay a hospital for services provided to Medicare and Medicaid patients. The government also determines a Medicare or Medicaid patient's out-of-pocket payment amounts (deductibles and co-insurance), if any.
Medicare Part A generally pays for inpatient hospital services. Some other services received in the hospital, such as physician services, emergency and outpatient care may be paid by Medicare Part B. Medicare Advantage plans are offered by private insurance companies that are approved by Medicare to provide both Part A and Part B benefits. Medicaid programs are required to cover all inpatient and outpatient services, among other things.
For individuals who do not have insurance, carry out-of-network insurance, or who receive services their insurance does not cover:
Our hospital offers a variety of financial assistance programs, including charity care and discounts for uninsured individuals.
We also provide eligibility screening services that can help identify the availability of resources to cover medical services, such as Medicaid.
COVID-19 Diagnostic Testing
The cash price for a COVID-19 diagnostic reference lab PCR test is: $157.00. The cash price for a COVID/Flu Antigen test is 140.00. The cash price for a full molecular Respiratory Panel which includes COVID-19 is 670.00. We provide this information to our patients, health insurers, and the general public, pursuant to Section 3202 of the Coronavirus Aid, Relief, and Economic Security Act.
IMPORTANT INFORMATION REGARDING WEBSITE CONTENT
Before using this cost estimation tool, please carefully consider the following information. By proceeding, you are acknowledging that you have read the information below and that you are accessing this information for the purpose of determining your estimated costs associated with healthcare services for yourself or a covered family member.
You, as the patient, are responsible for the cost of procedures or services not covered by your insurance plan. It is recommended you consult your carrier prior to any procedure or admission to understand what is covered, that the services provided are in-network and any limitations that may apply to your coverage plan.
The costs provided in this tool are estimates only and are not a guarantee of payment or benefits. The estimates are based on the selected provider's contract rates/fee schedule with your insurance carrier. Your actual cost may be higher or lower than the estimate provided, for various reasons. This estimation tool does not include physician fees or other third party provider services (radiologist, pathologist, anesthesiologist, etc).
Additional charges may apply for care provided through an emergency department or to address unknown or unexpected conditions that emerge while receiving care.
Information provided on this site does NOT guarantee eligibility, coverage, or payment by your insurer or other third-party payor. Neither does it determine or guarantee the benefits, limitations or exclusions of your coverage. For a complete description of the details of your coverage, please refer to the information provided by your health insurance carrier.
For any questions about the estimate, please contact the Lavaca Medical Center Registration Department at 361-798-3671.
Why costs may vary:
The cost estimates provided may be different from your actual costs for several reasons, including but not limited to:
your unique medical services/treatments and the decisions made by you or your health care provider as to what services you will receive; if the services you receive are different from or in addition to the services selected during the estimation process.
location of where your services are received differs from what is selected during this estimation process.
if your year-to-date benefit information changes between the time you receive this estimate and the time at which you receive care.
if your healthcare provider's contract with your insurance carrier changes.
I HAVE READ AND UNDERSTAND THE ABOVE LIMITATIONS AND I FULLY UNDERSTAND THIS IS ONLY A GOOD FAITH ESTIMATE.
The 2021 Standardized Charges for services at Lavaca Medical Center and Lavaca Family Health Clinic can be downloaded below by clicking the Download button.
Select link below to view the LMC Price Estimate tool: