Understanding Hospital Charges
Children's Hospital of Philadelphia (CHOP) is committed to the quality, safety and value of the care that we provide, and we recognize that understanding hospital charges can be confusing for many families.
While there are standard charges, there is no standard patient or treatment, and Chargemasters alone do not paint a complete picture of a patient’s financial responsibility. Additionally, since pediatric services generally require additional resources (children are not simply small adults), it is difficult to compare pediatric charges to adult charges.
The Hospital Chargemaster includes items and services such as: procedures; overnight stays; supplies; and technical services, such as lab tests and radiology studies. Hospital charges are based on the cost of providing patient care; both direct and indirect costs are taken into consideration. Direct costs include staffing costs and equipment costs for the services provided. Indirect costs include building expenses, such as electricity, security services, environmental services, an array of services that make procedures more comfortable for children and revenue cycle expenses (registration, billing, collections), as these services cannot be separately charged.
Hospital charges and bills do not include charges for physician’s professional services. These are billed separately by the physicians who provide the services. For example, when a patient receives an imaging service, they will receive a bill from the hospital for the technical portion of the X-ray and a separate bill from the radiologist who reads/interprets the X-ray.
A patient’s individual financial responsibility for hospital charges is guided by many things. Insurance coverage, specific terms of individual health insurance plans, financial assistance for families with demonstrated financial need, and/or prompt pay discounts all affect a patient’s financial responsibility for particular services or procedures.
Our goal is to provide CHOP families and prospective CHOP families with not only a listing of our charges, but also offer more accurate financial responsibility estimates based on insurance information available to CHOP.
CHOP has a Cost Estimation Team and offers an electronic Cost Estimation Tool on our website. Our Cost Estimation team works with many departments here at CHOP to bring the most up-to-date benefit information to the forefront of financial customer service.
What is the CHOP Cost Estimator Tool?
CHOP has developed this cost estimator tool to give you an idea of the amount you will be required to pay for certain services. However, there are limitations and the estimate you receive is not a guarantee. The estimate may be different from the actual amount you are billed after your child’s service is complete. Access the CHOP Cost Estimator Tool.
What is the Patient Cost Estimation Department?
- We are a specialized department at CHOP that provides families with estimates related to their out-of-pocket costs for scheduled or proposed services. We utilize contractual information and real-time eligibility to assist in our efforts.
Why would anyone need to contact the Patient Cost Estimation Department?
- Eligibility and benefit coverage checks for upcoming appointments.
- Provide awareness of out-of-pocket personal costs related to individual deductibles, coinsurances and copayment responsibilities.
- Review of payment arrangement options for patients eligible for financial assistance.
How can families/ CHOP representatives reach Patient Cost Estimation?
- By email at PatientCostEstimates@email.chop.edu
- By phone at 267-426-1467
- Through MyCHOP Billing, if you are a MyCHOP user. To request a MyCHOP access code, contact your CHOP provider.
- Via CHOP.edu
What information is needed?
- Patient Medical Record Number, if applicable
- Patient name and date of birth
- Appointment date
- CPT code or procedure name
- Insurance coverage, if applicable
A team member will connect with families, review the estimate, send a copy of the estimate and answer any insurance-related questions.