Many inpatient services are paid based on a Case Rate or a DRG (Diagnosis Related Grouping) rate. In these instances, ChristianaCare is paid a standard dollar amount that has no relevance to the actual charges on the claim. The case rates and DRGs are agreed upon with the payers. The patient typically owes a deductible, copayment or coinsurance amount that is based on that standard dollar amount (not based on our charges). This is a complex concept and our Customer Service Representatives are happy to answer your questions at 302-623-7440. Other inpatient services are paid based on a percentage of our charges, but because services provided in an inpatient setting vary based on the needs of each patient, you have been provided with an average reimbursement from each contracted payer.
Many inpatient services are paid based on a Case Rate or a DRG (Diagnosis Related Grouping) rate. In these instances, ChristianaCare is paid a standard dollar amount that has no relevance to the actual charges on the claim. The case rates and DRGs are agreed upon with the payers. The patient typically owes a deductible, copayment or coinsurance amount that is based on that standard dollar amount (not based on our charges). This is a complex concept and our Customer Service Representatives are happy to answer your questions at 302-623-7440. Other inpatient services are paid based on a percentage of our charges, but because services provided in an inpatient setting vary based on the needs of each patient, you have been provided with an average reimbursement from each contracted payer.
This is our price for each service.
Maternity delivery and newborn services are inpatient admissions. These services are paid on a DRG basis. A DRG, or diagnostic related grouping, is how Medicare and some health insurance companies categorize hospitalization costs and determine how much to pay for a patient's hospital stay. The DRG is calculated from a combination of diagnoses and procedures that are specific to you or your newborn during your hospital stay. DRG descriptions include CC and/or MCC. CC is a complication or chronic disease. MCC is a major complication or chronic disease. The information available below is the average charge amount for services based upon common grouping related to a specific medical need.
Industry standard code that describes a service
Many inpatient services are paid based on a Case Rate or a DRG (Diagnosis Related Grouping) rate. In these instances, ChristianaCare is paid a standard dollar amount that has no relevance to the actual charges on the claim. The case rates and DRGs are agreed upon with the payers. The patient typically owes a deductible, copayment or coinsurance amount that is based on that standard dollar amount (not based on our charges). This is a complex concept and our Customer Service Representatives are happy to answer your questions at 302-623-7440. Other inpatient services are paid based on a percentage of our charges, but because services provided in an inpatient setting vary based on the needs of each patient, you have been provided with an average reimbursement from each contracted payer.
Many outpatient services are paid based on a Fee Schedule or Outpatient Prospective Payment System methodology (OPPS). This is a complex concept and has no relevance to our charges. When there is a direct fee schedule or OPPS reimbursement tied to a charge, you have been provided with that amount. Where we are paid based on our actual charges, you are provided with that amount.
If there is not an ability to state an exact price because multiple charges are tied to a service or because the charges are specific to the needs of each patient, the shoppable service is presented with the average charge.
The maximum contracted reimbursement from any payer for this service.
The minimum contracted reimbursement from any payer for this service.
The amount a patient would be responsible for if you have no insurance.
