The tables below provide charges and negotiated rates for Regional One Health, Regional One Health Extended Care Hospital, Regional One Health Inpatient Rehabilitation Hospital, Regional One Health Skilled Subacute Care, and UT Regional One Physicians (UTROP).

The tables are updated annually and are based on the patient charges actually incurred for these services during the previous twelve months of our fiscal year. They may be used by patients to estimate charges they may incur for services as well as their expected discount based on current negotiated rates with third party payors.

Please note that these are only estimates and are subject to change without notice as services are added or removed or negotiated rates change.  Drugs, implants, and supply charges are based on acquisition costs so the charge could be different each time we purchase new items.  Also, the charge for your services may be higher or lower based on factors specific to your case. Total charges often vary based on how long it takes to perform a procedure, your recovery time, medications, complications, and other health conditions present at the time of service.

Shelby County Health Care Corporation
Regional Medical Center Extended Care Hospital
UT Regional One Physicians (UTROP)

Patient Out-of-Pocket Expenses

For patients with insurance, out-of-pocket costs can include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren’t covered under your insurance plan.

Insured Patient Responsibility Amounts:

Deductible
A deductible is the amount of money you have to pay for healthcare costs every year before your health insurance coverage begins to cover the cost of your care. Depending on your insurance plan, you can have either an individual or a family deductible.
Copayment or Copay
This is flat fee your health insurance requires you to pay for a designated health service.
Coinsurance
The cost-sharing amount that you owe based on your health plan’s negotiated rate. You and your health insurance company each pay a percentage of your covered medical costs, after you have paid your annual deductible amount.
Maximum out-of-pocket
This is the most you have to pay for healthcare costs in a year. After you spend this amount on deductibles, copayments and coinsurance, your health insurance pays 100% of your medical costs. The maximum out-of-pocket limit doesn’t include your monthly premiums.

If you have insurance the most accurate way to determine what your out-of-pocket expenses will be is to contact your insurance company. Links to some of our in-network Payor Partner Patient Portals are below:

Aetna
Ambetter
BCBS of TN
Bright Health
Cigna
Humana
United
Wellcare

Glossary of Terms

Inpatient Hospital Care in which the patients remain under constant care

Payment category used to classify patients for the purpose of reimbursing hospitals for each case in a given category with a fixed fee regardless of the actual cost incurred. The primary APC represents the highest weighted (most complex) procedure performed. The charges listed include all services (surgical procedures, supplies, drug costs, etc.) performed on the date of service.

The average charge amount is calculated by adding the total hospital charges for all patients in the last 12 months who obtained a specific outpatient test or procedure. This total number is then divided by the number of patients in that same category.

The average charge per day amount is calculated by adding all of the hospital charges for all patients in the last 12 months who obtained a service. This total number is then dived by the length of stay for the patients in the same category.

The average charge amount is calculated by adding the total hospital charges for all patients in the last 12 months who obtained a specific outpatient test or procedure. This total number is then divided by the number of units in that same category.

CPT® is a registered trademark of the American Medical Association (“AMA”). Current Procedural Terminology (CPT) codes are numbers assigned to services and procedures performed for patients by medical practitioners. The codes are part of a uniform system maintained by the American Medical Association (AMA) and used by medical providers, facilities and insurers. Each code number is unique and refers to a written description of a specific medical service or procedure. CPT codes are often used on medical bills to identify the charge for each service and procedure billed by a provider to you and/or your insurer. Most CPT codes are very specific in nature. For example, the CPT code for a fifteen-minute office visit is different from the CPT code for a thirty-minute office visit.

The highest rate that the hospital has negotiated with all third-party payers for an item or service.

The lowest rate that the hospital has negotiated with all third-party payers for an item or service.

Charge that applies to an individual who pays cash, or cash equivalent, for a hospital item or service.

Services provided by the hospital or hospital-based department

Charge for an individual item or service that is reflected on a hospital’s chargemaster, absent any discount.

Inpatient Procedure require that the patient by admitted into the hospital for at least one overnight stay.

Care Provided in an inpatient setting for patients that need additional help to recover from an injury

Specilaty care for patients with serious medical problems that require intense, special treatment for an extended period of time- usually 20 to 30 days

Major Diagnostic Categories (MDC) are formed by dividing all possible principal diagnosis into exclusive areas. The diagnoses in each MDC correspond to a single organ system or etiology, and in general are associated with a particular specialty. MDC 0 (Pre) can be reached from a number of different diagnosis or procedures- usually related to transplants or ventilators.

The maximum charge per case is the highest charge per case in the last 12 months for patients that received services grouped by either MS-DRG (inpatient) or primary APC (outpatient).

The Median Charge Per Case represents the middle charge her case in the last 12 months who obtained services grouped to an MS-DRG (inpatient) or Primary APC (outpatient). The probability of falling above this charge or below it is equal.

Lists the Hospital Outpatient Prospecitve Payment System (OPPS) classifications and rates by CPT. This system is used by Medicare, Medicaid, VA, Tricare, and other payors to determine how hospital outpatient services will be paid. Services that are not billed with a CPT are not separately payable under OPPS.

The Status Indicator listed in Addendum B explains the payment methodology used by OPSS for each CPT.

The minimum charge per case is the lowest charge per case in the last 12 months for patients that received services grouped by either  MS-DRG (inpatient) or Primary APC (outpatient).

Payment category used to classify patients and for the purpose of reimbursing hospitals for each case in a given category with a fixed fee regardless of the actual costs incurred and that are based especially on the principal diagnosis, surgical procedure used, age of patient, and expected length of stay in the hospital

Services that are provided by the physician or medical group. These services are billed in addition to the facility services.

An outpatient procedure is one that is performed in the hospital or hospital-based deparment and does not require an overnight stay

The rate the hospital has negotiated with a third party payer for an item or service.

A Per Diem is a per day rate that is multiplied by the patients length of stay to determine reimbursement.

Anesthesiologist help ensure safety and comfort for patients undergoing surgery by administering general anesthesia (putting the patient to sleep), sedation (IV medications that make patients calm and/or unaware), or regional anesthesia (injections of anesthesia near nerves to numb the part of the body being operated on. The professional part of these services is separately billed by the Anesthesiologist’s office

High level of medical care for patients that are no longer in need of acute services, but require additional medicare care from trained individuals (nurses) before they go home.

List of MS-DRGs that is updated annually by CMS which includes the DRG weights and arithmetic mean length of stay, as well as the geometric length of stay.

For Patients Without Insurance

Please click here to receive more information on our financial assistance policy

Cost Estimates for Shoppable Services

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These services are not generally covered by Third Party Insurance Plans