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Costs & Pricing Transparency

While quality and safety are top priorities, let’s face it, the cost of health care is a big consideration.

MUSC Health has been reporting cost data to the federal government’s Centers for Medicare and Medicaid Services for years. Now we’re taking steps to make financial information available to patients and their families.

You have a right to know what things cost. But that is easier said than done. Hospitals have what they call a master charge list. It’s kind of like the room rate you see on the back of hotel doors. That’s the most the hotel – or a hospital – will charge. The reality is that hospitals are paid what the insurance company has negotiated and will allow. That differs for Medicare, Medicaid, Tricare, private insurance companies (such as Humana or Cigna) or other "payers," as they are called. That can also differ from hospital to hospital, based on a number of factors including such things as the quality outcomes of the hospital, the percentage of patients who have no means to pay, specialized services that are not offered everywhere, and so on.

What you as a patient have to pay also differs based on the terms of your insurance contract. Each plan has a different deductible, different co-pay and different stop loss (the most you have to pay out of pocket).

Ultimately, the amount you pay for any procedure or hospital stay is between you and your insurance company. However, MUSC Health does want to help make the potential cost for our services clearer to you.

Pricing Transparency

MUSC Health has signed on with other hospitals who are members of the South Carolina Hospital Association (SCHA) to provide as close to an apples-to-apples comparison of cost for many common procedures.

After studying the best practices hospitals across the country use to provide meaningful data to patients and families, SCHA has decided to implement a program called Price Point.

SCHA worked with the Wisconsin Hospital Association to build and maintain the SC Price Point Website.

  • Wisconsin’s Price Point is used in 12 states (Wisconsin, Iowa, Texas, Washington, Oklahoma, Virginia, Montana, Nebraska, Nevada, Oregon, South Dakota, and Wyoming).
  • It updates the data quarterly.
  • It has been tested and proven.
  • A group of Price Point users already share best practices and trouble shoot issues.

South Carolina will study and move forward with a number of enhancements. These might include:

  • Average charges and number of cases for select number of frequently billed DRG or CPT codes.
  • Audited, consolidated financial statements of hospitals to accurately show profitability.
  • Charity and bad debt numbers by hospital.
  • Payer mix for each hospital.
  • Links to hospital policies regarding financial assistance.
  • General consumer information about the health care system.
  • Information on where to go for help in finding insurance.
  • And possibly a cost estimator.

MUSC Health is fully supportive of the South Carolina Hospital Association method, because it will provide standardized data that will be helpful as part of the decision process to patients, providers and others interested in managing the costs of health care.

Insurance Plans That Include MUSC Health

Nowadays, insurance plans often limit the doctors and hospitals you can use. For instance, only five of the many Blue Cross and Blue Shield plans cover costs at MUSC hospitals. We maintain a comprehensive list of the insurance plans that include the MUSC Health network. It changes from time-to-time. And there may be exceptions for certain treatments or procedures. Check with your insurance carrier to be sure MUSC Health is in network. If it's not, ask your employer or insurance company to offer it next year.

Take the time to inform yourself and choose the insurance plan that's right for your family. Whether you are choosing among plans offered by your employer or purchasing individual plans from private companies or the insurance exchanges, you owe it to yourself and your family to learn everything you can.

What you will be missing if MUSC Health is not in the network you choose:

  • The #1 hospital in South Carolina as ranked by U.S. News & World Report.
  • The only NCI-designated Cancer Center in South Carolina.
  • Access to the many sub-specialties only available at a comprehensive Children’s Hospital.
  • Critical care at the Lowcountry’s only Level 1 Trauma Center and pediatric trauma center.
  • South Carolina’s only Transplant Center.