You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an
in-network hospital or ambulatory surgical center, you are protected from
surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is
involved in your care—like when you have an emergency or when you schedule a visit at an innetwork facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out of network provider or facility, the most the provider or facility may bill you is your plan’s innetwork cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain
providers there may be out-of-network. In these cases, the most those providers may bill you is
your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia,
pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist
services. These providers can’t balance bill you and may not ask you to give up your protections
not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance
bill you unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
– Cover emergency services without requiring you to get approval for services in advance (prior authorization).
– Cover emergency services by out-of-network providers.
– Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
– Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may visit www.cms.gov/nosurprises or call 1-800-985-3059.
Cheyenne Regional Medical Center (CRMC) is committed to providing meaningful pricing information to our patients so they can make informed healthcare decisions.
CRMC encourages patients who currently have private health insurance, Medicare and/or Medicaid to contact their health insurance carriers to understand their financial responsibilities for healthcare services provided at CRMC.
Patients not covered by private health insurance, Medicare and/or Medicaid and who plan to pay for healthcare services directly are encouraged to call CRMC’s Financial Navigator Department at (307) 633-7623 or to visit Patient Access/Registration at the CRMC – West Campus. Our West Campus is located at 214 East 23rd St.
Cost estimates for services and procedures performed at CRMC are available from Patient Access/Registration Department or by calling (307) 633-7630 Monday through Friday from 7:30 a.m. to 5 p.m. Patients can also complete an estimate on MyChart.
To provide the most accurate estimate of what you may pay for services, one of our Patient Access Representatives will ask you for the following information:
- Name of insurance company
- Policy holder / member name
- Policy number
- Group name and number
- Insurance company phone number
- Test procedure or CPT code
Estimates are provided for both self-pay and insured patients. Estimates generally include charges for services and procedures performed at CRMC. This includes all routine supplies and medications, x-rays and lab tests. Services provided by independent or third-party physicians such as anesthesiologists, emergency room physicians, non-employed surgeons and pathologists are not included in the estimate and are billed separately by each physician.
The actual charge for services provided during a CRMC visit may be affected by physician decisions and by any complications and unforeseen conditions that may require additional procedures, treatments and/or supplies. Total charges assessed to a patient’s account may be above or below the estimate provided.
To improve price transparency, all U.S. hospitals and health systems are required to provide lists of standard hospital charges ― also called a chargemaster ― so patients can compare prices across hospitals. Here are a few considerations to keep in mind as you view the list of standard charges (chargemaster).
- These charges are rarely the price that patients pay. The chargemaster lists the dollar amount set for each service prior to insurance contract/benefit plan discounts or self-pay discounts being applied, so the price patients pay tends to be less than the standard charge.
- Hospital charges differ from patient to patient for the same service depending upon variations in treatment.
- Patients who are eligible for financial assistance also receive additional discounts.
- Items included in a charge vary across hospital systems. For example, what’s included in one hospital’s charge for room and board may differ from other hospital’s charge ― some hospitals bundle services together into a single charge that others may list separately.
- Looking at various hospital charges does not provide any indication of quality of service and outcomes.
Cheyenne Regional Medical Center Average Charges by Type of Patient Group
All hospitals and health systems also are required to provide a listing of average charges by types of patient groups, referred to as MS-DRGs (Medicare Severity Diagnosis Related Groups). Patients can view similar listings posted by different hospitals, which provide a more direct comparison of charges than the standard charges in the chargemaster. View the list of average charges by type of patient group (MS-DRGs).
Cheyenne Regional Medical Center Shoppable Services Prices
All hospitals and health systems also are required to post a list of at least 300 Shoppable Services along with the corresponding prices for each of those services. Each of these Shoppable Services includes the following amounts: Gross Charge, Discounted Cash Price, Payer-Specific Negotiated Charges, De-Identified Minimum Negotiated Charge, and De-Identified Maximum Negotiated Charge.
For additional questions about CRMC’s charge master, please call (307) 633-3016 or (307) 633-6198.
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Making copies or utilizing the content of the UB-04 Data file or UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from Health Forum LLC, a subsidiary of the American Hospital Association.
CRMC will accept payments from self-pay or uninsured patients prior to or at the time services are provided. Those unable to meet their financial obligations prior to their scheduled procedures can contact CRMC’s Financial Navigator Department at 307-996-4793, to determine available payment options or to schedule a free appointment to discuss payment options.
Financial challenges or lack of health insurance should not prevent anyone from receiving needed medical care. CRMC offers many resources to help patients get the care they need. To learn more about these resources, including public benefits, Medicare, Wyoming Medicaid, discounted health insurance plans, financial assistance or other discount programs, call CRMC’s Financial Navigators at 307-996-4793.
Patients who have questions about their billing statements or payment plans can call CRMC’s Customer Service Call Center at (307) 996-4777. Payment plan options may be available for those unable to make their current payments or meet their financial responsibilities.Information on billing process and payment plans