How are prices established for services?
Each hospital has its own policy for setting prices. Hospital charges vary because they reflect the individual hospital’s mission and the Patient population it serves.
A hospital that provides highly specialized services, such as trauma units or dedicated intensive care services, like UM Health-Sparrow, has a different cost structure and pricing than one that does not.
Prices are reviewed each year on Jan. 1, and are subject to change during the year. To establish prices, we consider many factors including:
- The cost of staff, equipment, medications and other supplies involved in Patient care
- The amount of time our facilities and staff are involved in providing services
- The cost of administrative expenses such as billing, technology, housekeeping, etc.
- Insurance company contracts
- Information provided by the Centers for Medicare and Medicaid Services, the federal agency that manages the Medicare and Medicaid programs
Do these prices reflect the total cost?
Not necessarily. In addition to your hospital charges, you could receive separate bills for physician’s fees from your surgeon, anesthesiologist, radiologist, emergency room physician and other specialists. Please contact those offices directly for price information:
- Anesthesiology – 517.484.2777
- EKG (test interpretation) – 517.364.3278
- Emergency Services – 517.364.4149
- Imaging/Radiology (test interpretation) – 517.364.2300
- Surgery – Contact your surgeon’s office. If you have not selected a surgeon or need a referral, call 1.800.UM Health-Sparrow or visit our Find a Doctor page.
What is a CPT Code?
CPT stands for Current Procedural Terminology. A CPT code is a five-digit code used by all hospitals, physicians, and insurance companies to identify a type of service or procedure. You will see CPT codes located on our pricing lists to help ensure that you are viewing the price information for the specific procedure your physician has ordered.
What is a DRG?
DRG stands for Diagnosis Related Group. A DRG is only assigned to an inpatient hospital service. DRGs are universal groupings used by Medicare and most insurance companies to clarify the type of inpatient care a Patient receives. Insurance companies use the DRG code, along with a diagnosis/CPT code and the length of the inpatient stay, to determine payment and reimbursement for claims.
What if a procedure is not listed on the website?
Charges for many common, high-volume procedures are listed on our site. Additional service areas are being added regularly. Please contact a UM Health-Sparrow Financial Assistance Specialist at 517.364.6060 for pricing on a procedure not listed.
Will my bill be different than the price listed here?
The amount you owe may vary due to a number of circumstances:
- Additional testing, medications, services or procedures ordered by your physician
- The procedure planned may not be the procedure performed based on your physician’s assessment
- If you have insurance, the type of insurance you have, your deductibles, coinsurance, and out-of-pocket limits will determine your final UM Health-Sparrow bill.
Where can I get information on the quality of health care at UM Health-Sparrow?
UM Health-Sparrow is developing a quality of care report card for the public showing current data that is clear to all audiences to help people make decisions about their care. Work is expected to be completed on this project later this year and made available on our website.
Our Patients’ safety and preventing hospital-acquired infections is a major focus at UM Health-Sparrow. We are proud that we perform better than national benchmarks in the majority of categories of hospital-acquired infection rates. Our Caregivers are dedicated to improving in this area, and it remains a constant priority for UM Health-Sparrow.
If I have insurance, does this reflect how much I will have to pay?
No. The amount you will be responsible for will depend on your specific insurance plan. We have provided an average of the reimbursement UM Health-Sparrow receives from insurance companies for these procedures, but our Patient Financial Services Department can assist you in determining an individual estimate of your out-of-pocket costs based on your personal insurance policy.
What insurance companies does UM Health-Sparrow accept?
Click here for a list of insurance plans and whether UM Health-Sparrow is considered an “in-network” or “out-of-network” provider. Or, call your insurance provider directly to verify that UM Health-Sparrow is in your network.
UM Health-Sparrow will file claims to any insurance company you authorize, but your employer and insurance company determine your level of coverage. An insurance contract between your insurance company and UM Health-Sparrow doesn’t guarantee that your claims will be paid in full. You’re responsible for payment of services not authorized by your insurance company and any balance remaining after insurance payments and adjustments have been applied.
If UM Health-Sparrow is “out-of-network,” may I still receive care at UM Health-Sparrow?
Yes. In an emergency, always go to the closest hospital. Your insurance provider generally will cover emergency department costs or recommend a transfer to an “in-network” hospital when it is safe to do so.
If you choose to go to an “out-of-network” hospital in a non-emergency, you may be required to pay a larger deductible or a greater portion of your bill. Call your insurance company to find out your health plan’s “out-of-network” options.
How will I know how much I owe?
Your health plan may require a co-payment or deductible that will be due during appointment registration. Check with your provider on the amount that you will be responsible for at this time.
Following your healthcare services, your insurance provider will send you an Explanation of Benefits (EOB), which will detail the amount it has paid, any non-covered or denied amounts, and the remaining balance that you are responsible for paying to UM Health-Sparrow.
Review this EOB, compare it to your UM Health-Sparrow billing statement, and call your insurance provider or a UM Health-Sparrow Financial Assistance Specialist if you have questions or concerns.
Can I receive an estimate for the cost of a procedure before I receive the service?
Yes. We can help you determine the cost of a medical procedure or service. Contact UM Health-Sparrow Financial Assistance Services at 517.364.6060 to speak to a Specialist. Please be sure to have your health insurance card, the name of your Physician, and information about the procedure you will be having ready before you call.
Is there help if my health insurance does not cover my bills?
Yes. UM Health-Sparrow Financial Assistance Specialists assist individuals and families that have health insurance but who need additional financial resources to cover medical bills. We can identify and help you apply for programs including Medicaid, Social Security, and other financial assistance.