Hospital Charges Policy

POLICY STATEMENT:
Hospital charges are an important component of the healthcare system and as such charge items are frequently added to, removed from, or otherwise edited. Many factors enter into the process of producing a bill for services provided. It must be acknowledged that the list of items and charges referred to in this policy cannot be considered to be a legal document used to calculate final charges that may be incurred for any services provided.

POLICY:
It is the policy of Trace Regional Hospital to provide, upon receipt of a written request, a copy of the facility charge master in either paper or digital form to be sent within 3 business days of receipt of request. The written request may come from either a physical form submitted to the facility, or by means of form submission through links provided on the facility web site.

CRITERIA:
to be provided by the person requesting the charge information:
The prospective patient’s name and date of birth

The mailing address to be used if a paper copy is requested

The email address to be used if a digital copy is requested

A current working phone number that can be used to reach a responsible party

The prospective patient’s healthcare provider name and city address

Approximate anticipated date of service

Anticipated services to be provided

Any basic insurance information (i.e. carrier name) the prospective patient is covered by

PROCEDURE:
Each person requesting a charge list will complete a form (including signature) to request the information. Blank copies of the form will be available upon request from any of the following facility staff members: Registration, Business Office, or Health Information Management. Additionally forms MAY be available for printing from links provided on the facility web site.

A copy of the paper form is available for download by clicking here. Charge_List_Policy

The completed request can be submitted to any of the following facility staff members: Registration, Business Office, or Health Information Management.

The request will be date and time stamped when received.

A copy of the facility charge master will be generated in either paper or digital form (per requesting form) and will be sent within 3 business days to either the street address or email address provided in the requesting form.

Once processed, requests received will be maintained and stored according to policy set by the Business Office Manager/Director.