KERALTY HOSPITAL PRICING INFORMATION

 

Keralty Hospital is committed to providing meaningful information to our patients related to the financial obligations for healthcare services. We want you to focus on what’s most important: your health. By providing pricing information for common services, we want you to understand the costs of services so that you have the information necessary to assist in making healthcare decisions. In compliance with Florida Statute §395.301, Keralty Hospital provides information regarding quality, price transparency and patient billing information.

 

Pricing Information  

  • Keralty Hospital provides access to a list of pricing for all services and procedures (Click here).

    * includes gross charges, self-pay cash prices and negotiated payer rates.
     
  • For a real-time estimate of an upcoming procedure or exam, please use the Keralty Hospital Cost Estimator Tool or call (305) 267-3800 to speak with a patient advocate. The CMS mandated machine-readable standard charges file for items and services for all payers and plans, including discounted cash prices, is available (Click here). The information provided in the estimate is a non-personalized estimate for anticipated services to you. These estimates are only related to Keralty Hospital services.
     
  • While the prices listed are the standard charges for a procedure, the price you pay may vary greatly depending on the actual services provided, existing health conditions, insurance coverage (if applicable) and financial assistance eligibility. As such, the amount you owe will be on your final bill and may be higher or lower than the estimate provided. Also, a provider’s professional charges may not be included in the estimate; this fee may be sent to you in the form of a separate bill. The final amount that you are billed will be determined based on the actual services rendered to you.
     
  • If you would like to compare Keralty Hospital’s pricing to other providers or facilities, you may visit the Florida Agency for Health Care Administration’s Florida Health Finder. This includes information regarding quality metrics and service bundle pricing information. The service bundle information provided is a non-personalized estimate of the costs that may be incurred by you for anticipated services.
     
  • Uninsured or underinsured patients should consult with Keralty Hospital patient advocates to determine whether they qualify for financial assistance. Please visit our Financial Assistance page for information regarding financial assistance and payment plans or contact a patient advocate at (305) 267-3800.

 

No Surprises Act & Good Faith Estimates

  • When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. “Balance billing” occurs when a provider bills you for the difference between the provider’s charge and the allowed amount. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
     
  • The No Surprises Act (the “Act”) prohibits providers and facilities from directly billing patients for the difference between the amount charged and the amount that the patient’s plan or coverage will pay plus the patient's cost-sharing amounts in certain circumstances. Surprise medical bills often arise when insured patients inadvertently receive care from (i) out-of-network hospitals and providers or (ii) providers they didn’t choose.
     
  • If you have private health insurance, the Act bans the most common types of surprise bills. The Act bans surprise billing for insured patients receiving emergency services out-of-network and without prior approval (prior authorization). It bans out-of-network cost sharing (ie., out-of-network coinsurance and copayments) for most emergency and some non-emergency services – you cannot be charged more than in-network cost-sharing for these services. It also bans out-of-network charges and balance bills for certain activities furnished by out-of-network providers as part of a patient’s visit to an in-network facility (ie., anesthesia, radiology). If you’re uninsured or you decide not to use your health insurance for a service (ie., self-pay), under the Act’s protections, you can obtain a good faith estimate of the cost of your care prior to your appointment. If you have Medicare and Medicaid, you are already receiving these protections and are not at risk for surprise billing.
     
  • The Act also requires that Keralty Hospital provide you with an easy-to-understand notice explaining the applicable billing protections and a point of contact at Keralty Hospital for billing-related inquiries.

 

Your Right to a Good Faith Estimate

  • Patients have the right to receive, and Keralty Hospital is required to provide, a good faith written estimate of reasonably anticipated charges for such services (i) once you schedule an appointment for a health care item or service or (ii) upon request. A good faith estimate is not a bill, but instead lists the expected charges for items or services from the provider or facility. The estimate may be the average charges for the treatment or procedure and the actual charges may exceed the estimate. The estimate is based on information known at the time the estimate was created (before the provision of services) and does not include any unknown or unexpected costs that may arise during treatment.
     
  • The estimate shall be provided to you within seven (7) business days after the receipt of a written request (paper or electronic). You are also entitled to receive notification of revisions to the estimate, upon request.
     
  • Typically, the good faith estimate must include the expected charges for (i) the primary item or service and (ii) any items or services that are reasonably expected to be part of the primary item or service for that period of care. The estimate may not include every item or service you receive from another provider or facility, even if some items or services may seem connected to the same service (ie., for a surgery, a good faith estimate could include the cost of the surgery, anesthesia, any labs or tests). In some instances, items or services related to a service that are scheduled separately, like certain pre-surgery appointments or post-surgery physical therapy, may not be included in the same good faith estimate.
  • You may also request an explanation of the good faith estimate by phone or in person.
     
  • Keep the estimate in a safe place so you can compare it to any bills that you later receive.
     
  • If you are billed for more than the good faith estimate amount ($400 or more), you may have the right to dispute the bill.

 

Requesting an Itemized Statement or Bill

You may request an itemized statement or bill from Keralty Hospital after your discharge or by request. The itemized statement or bill will be provided within seven (7) business days after the request or the discharge date, whichever is later. The itemized bill will contain a description of the individual charges by date. Physician services may be billed separately; you should contact the physicians providing services to obtain an itemized statement or bill for services provided. To request an itemized statement or bill, please contact a patient advocate at (305) 267-3800.

 

Health Plans

Keralty Hospital contracts with the health plans listed HERE. You are encouraged to contact your health plan directly for information regarding anticipated cost sharing responsibilities. Additional plans may be added and/or plans may be presented under an alternate name that may be different from what is listed above. Please contact a patient advocate at (305) 267-3800 so we can assist and provide the most current and accurate information.

 

Providers

Keralty Hospital partners with Physicians (Click here) to provide medical services within the hospital. Services at Keralty Hospital provided by practitioners not employed with the hospital are billed separately. You should contact the health care practitioner who will provide services to you to determine which health plans the practitioner participates in as a network provider or preferred provider.

Information about Keralty Hospital’s healthcare practitioners is available HERE.