Pricing Transparency

Frequently Asked Questions

• What is the new CMS regulation, and what does it require?

  In October 2018, the Centers for Medicare and Medicaid Services (CMS) established a new requirement that hospitals post a list of standard charges for hospital items and services by Jan. 1, 2019, as well as diagnosis-related group (DRG) average charges, on the Internet. The rule requires hospitals to list their charges, which are different from the amounts that either patients or insurers actually pay.

• Has UCSF Health complied with the regulations?

  Yes, we have complied with this new regulation. We are committed to helping patients and their families make informed decisions about every aspect of their care, including the out-of-pocket costs of their care, and have provided both lists in Excel and CSV formats on the Internet, so they are easily viewable, searchable, downloadable and printable.

• Haven't you been transparent about pricing in the past?

  Yes, and actually, UCSF Health has been posting these prices online with the State of California Office of Statewide Health Planning and Development for more than a decade, in accordance with the State of California Payers Bill of Rights of 2003. The site updates pricing information each June for all hospitals in California. In addition, price information is readily available at our facilities.

• Is this what I will actually be charged if I come to UCSF Health?

  The prices that hospitals are required to publish are not the amounts that either patients or insurers actually pay. As an individual patient, your responsibility would depend on your insurance plan, coverage, deductibles, co-insurance and other factors. Even if you have no insurance at all, your out-of-pocket costs would depend on the type and amount of care you receive. At UCSF Health, patients without insurance receive discounts, as well as assistance in accessing government insurance, as applicable. Likewise, actual insurance reimbursements are based on amounts established with commercial payors (health plans or insurers) or, for patients who are Medicare or Medi-Cal beneficiaries, by CMS and Medi-Cal.

• Why are the DRG charges so much higher than "standard charges"?

  The "List of Standard Charges," also known as the charge master list, reflects line-item charges for individual items, such as operating room, bone marrow procedures, etc. By contrast, the DRG is an average of the total charges for patients with a specific diagnosis, including all the line items that are involved in providing care. The average DRG total charges would be impacted by the acuity of an average patient's condition, his or her length of stay in the hospital, tests and medications, and other charges involved in his or her care. Note that this is not what any patient would actually pay: Not only are these the average total charges for all patients with that particular medical condition, but an individual patient's out-of-pocket responsibility would be influenced by his or her insurance coverage, deductibles, co-insurance and other factors.

• Why do different hospitals charge different prices for the care they provide?

  There are no specific requirements or consistent guidelines for how hospitals determine their charges. As a result, one hospital might combine the charges of some line items, while another may spell out each charge individually. Neither approach is right or wrong, and both comply with the federal rule; they are simply different ways of representing the charge for a therapy or procedure. In addition, some hospitals, including UCSF Medical Center and UCSF Benioff Children's Hospitals, serve as tertiary and quaternary referral hospitals, so other hospitals send patients who require more specialized care to these hospitals. As a result, the total charges for our patients normally include more extensive care, meaning potentially more line items and higher average charges.

• These price lists are extremely confusing. How do we make sense of them?

  Yes, this is extremely confusing. At UCSF Health, we have a team of financial assistance and counselors to help current and prospective patients understand their potential out-of-pocket costs. Our team makes every attempt to personalize these quotes to enable patients to make informed decisions and understand their potential financial liability, both before and after their care. We also offer financial assistance and discounts for patients who have no insurance or, for patients who qualify, help them enroll in available and appropriate Medicare and Medi-Cal programs. To speak with a staff member about a personalized out-of-pocket estimate specific to your visit and care, call the Patient Estimate Program toll-free at (844) 678-6831. For questions about our price list, please email us at [email protected].