Our Commitment to Pricing Transparency
Spencer Hospital makes patient satisfaction a priority, which includes pricing transparency related to the services it offers.
Contact Us for An Estimate
Healthcare pricing and insurance procedures can be complicated. The best way to understand your payment obligation is to seek information prior to receiving a service. You’re welcome to contact a Spencer Hospital Financial Counselor if you’d like to review and discuss estimated charges and how the charges could affect your financial obligations later. An estimate is based on routine services. Care needs can vary based on each patient’s particular circumstances, so actual charges may be more or less than an estimate provided.
A Financial Counselor can also discuss payment options with you, to include discounts, assistance programs and payment plans for which you may qualify. For a service estimate or to learn about payment options, simply call (712) 264-8300 and dial extension 6128 or 6259 for assistance.
Good Faith Estimate
You have ghe right to receive a "Good Faith Estimate" explaining how much your medical care will cost.
- Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Anticipate Potential Separate Bills
It’s important to understand that your total charges for care received at Spencer Hospital may include expenses beyond hospital services. This can include charges from your family physician, a surgeon, radiologist, pathologist, anesthesia provider and other medical providers who supported your care. In most instances when receiving care at Spencer Hospital, these charges are not managed by the hospital and you’ll receive separate bills from the medical providers who were engaged in your care.
Insurance Coverage Is a Factor
What you pay for hospital services is also a function of the insurance coverage you’ve selected from a private insurance company (such as Wellmark) or qualify for through a government program (such a Medicare, Medicaid, the Veterans Administration or the like). Insurance payments toward your care can vary widely based on decisions you make about your coverage levels and will impact your personal financial obligation.
Another key consideration to understand what you pay for hospital services is to know how hospital “charges” work. Every hospital sets a dollar amount, a “charge,” for each of its services. A charge is similar to a list price. However, hospitals rarely are paid the full amount of those listed charges.
Here’s how it works:
After you receive care at Spencer Hospital, we’ll send your insurance company a list of charges associated with your visit.
Your insurance company will review all charges and typically applies a discount, informing the hospital the price they will allow for each service. This is due to many factors, including payment deductions by government insurance programs and discounting procedures through private insurance companies.
After the allowed charge is established, your insurance company will pay the hospital the amount allowed by your specific coverage plan. You’ll then be notified of out-of-pocket costs you are responsible for in accordance with your chosen deductible and co-payment coverage levels.
Because so many variables impact what the final cost of your services are as compared to initial charges, it’s important to understand that a listing of charges is likely not what you or your insurance plan actually pays for your healthcare.
To provide a better understanding of what you or your insurance company is actually billed for a healthcare service, Spencer Hospital has compiled a spreadsheet of its 300 most common hospital charges. For each charge, the hospital’s major payers are listed and what each company is actually paying the hospital for that service in comparison to the listed charge. Click on this link to access the spreadsheet: 42-6005883 Spencer Municipal Hospital 300 Shoppable Services Pricing Transparency File. Please note this listing does not include Medicare charges. Reimbursement for Medicare services are not negotiated, but rather are established by the federal government through the Centers for Medicare and Medicaid Services. Some Medicaid charges are listed because Iowa’s Medicaid program is outsourced by the State of Iowa to private managed care companies.
Pricing Resources Available
Consistent with a commitment to be transparent about pricing practices, following are resources that share information about Spencer Hospital’s charges:
By clicking here, you can view a listing of our “Average Charge per Diagnostic Related Group.” This is the hospital’s average total charges for an inpatient episode of care for a specific diagnosis. The file is machine-readable, so you should be able to view it on multiple devices and operating systems. If in your view, you see a cell that contains a series of hashtags - ##### - be sure to expand the cell size or click on the cell to see the numbers within the cell. Views may vary depending on the resolution and screen size of your viewing devise.
Additionally, you can click the following link to view or download a list of our standard charges: 42-6005883 Spencer Municipal Hospital Standard Charges This file is also machine-readable.
To obtain a better understanding of what your insurance provider reimburses the hospital for a service, click here to open the spreadsheet of the 300 most common Spencer Hospital charges. This lists the contract rate established with the most frequently used insurance providers: 42-6005883 Spencer Municipal Hospital 300 Shoppable Services Pricing Transparency File
Please understand that hospital charge levels are typically not a good indicator of what your final hospital financial obligation will be. The payment practices of your insurance company and your choice of insurance coverage is a much better indicator of what you will pay. Accordingly, if you seek a better understanding of financial obligations associated with a service at Spencer Hospital, you’re encouraged to contact one of our Financial Counselors prior to receiving your care.
COVID-19 Diagnostic Laboratory Testing Price
The price of a COVID-19 lab testing (CPT 87635 and U0001) at Spencer Hospital is $96.00 or $54.00 depending on where the test is sent for processing (inclusive of supplies, lab equipment and staff time to perform the test). Many insurance companies, as well as government programs such as Medicare and Medicaid, have taken steps to ensure coverage to eliminate any out-of-pocket costs for COVID-19 testing. For any self-insured patients, there will not be a bill at this time. Spencer Hospital will seek reimbursement from any applicable government programs, which may provide coverage for the testing charges.
Click here for Copyright notice for use of UB-04 Revenue Codes.
Your Rights and Protection Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balanced billing.
Surprise Medical Bills FAQs
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.
If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s in- network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out- of-pocket limit.
If you believe you’ve been wrongly billed, you may contact 1-800-985-3059.
Visit www.cms.gov/nosurprises for more information about your rights under federal law.