Oklahoma PricePoint System

Welcome to OKHospitalPricing.org, a user-friendly resource for hospital charges, utilization, and payer mix information for Oklahoma hospitals. OKHospitalPricing.org is sponsored by the Oklahoma Hospital Association, a nonprofit trade association representing hospitals and health systems in the state of Oklahoma.

Oklahoma hospitals believe that patients have a right to know more about the prices hospitals charge for services as well as information about how hospitals are reimbursed for the care they deliver and how much care delivered is not reimbursed.

In response, OHA has produced OKHospitalPricing.org, a database of hospital charges, utilization and payer mix. Specifically, using this site, you can find:

Hospital charge information for services at Oklahoma hospitals and the average length of stay.
Information about how much of each hospital’s business comes from each of three major payment sources: private insurance, Medicare, and Medicaid.
Aggregate information on the amount of charges paid to each hospital for the three major kinds of health care coverage – private insurance, Medicare and Medicaid. This information allows you to see how hospitals’ charges compare to the amount of revenue they actually collect for services provided to the three payer categories.
Information about the amount of charity care and other uncompensated care each hospital delivers.

All the data on this Web site were collected by the Oklahoma State Department of Health, a state agency and independent source.

The intent of this Web site is to promote informed discussion among consumer, insurers, and providers of care. Understanding how to use this information is just as important as knowing how to access the data.

A hospital “charge” is not the same as “expected payment.” “Charge” is the amount billed for services. In the vast majority of cases, the hospitals are paid considerably less than the billed amount. Because each person’s case is different based on the patient’s medical condition, a given person’s charge will not necessarily be the same as the average or median charge. Furthermore, the actual amount paid by a patient will depend on their insurance coverage. For example, most out-of pocket hospital costs for privately insured patients are determined by their health insurance policies, which have negotiated specific discounts with a hospital or health system. The bill does not reflect the actual hospital costs. The hospital’s charge does not include professional fees such as physician’s or surgeon’s services.

The content on this Web site is intended for informational purposes only. This information should not be used solely when making health care decisions. OKHospitalPricing.org should be used as a starting point for comparing costs of care between Oklahoma hospitals. Patients should talk with their insurance provider to understand which costs will be covered, and which will be the patient’s responsibility.

This Web site contains information on the most common services and may not address specific questions that you may have. Please use the information on this Web site to talk to your health care provider, hospital and health insurance provider to help you and your family make the best health care decisions for your circumstances.

Hospitals and health systems in Oklahoma have financial assistance policies to help low-income patients pay their hospital bills. These policies explain eligibility for free and discounted care. Please check with the individual hospital for their charity care policy.

Things to Know When You Look at Oklahoma Hospital Pricing Reports

IF YOU HAVE PRIVATE INSURANCE:

Private insurance, often employer-based, is an individual or group policy with a commercial insurance company or other health plan.
Private insurers negotiate discounts with hospitals on behalf of the patients they represent. The discounts vary among insurers.
Numerous factors, such as type of plan, co-pay, co-insurance, deductible, out-of-pocket maximums and any limitations on coverage such as whether or not the hospital is a participating provider in the insurance plans network also will affect your financial responsibility to a hospital.
Begin by contacting your insurance company to understand all of the factors affecting your financial responsibility.

IF YOU HAVE MEDICARE:

Medicare pays hospitals according to a set fee schedule that represents a discount from a hospital’s billed charges.
Medicare will pay for many of your health care expenses but not all of them.
Special rules apply if you have employer group health insurance coverage through your own job, a spouse's job or coverage through a Medicare HMO/PPO.
If you have a supplemental insurance policy, it may cover some costs Medicare does not cover.
Contact Medicare at http://www.medicare.gov/ .

IF YOU HAVE MEDICARE MANAGED CARE (PPO or HMO):

Medicare Choice plans and PPOs negotiate discounts with hospitals on behalf of the patients they represent. The discounts vary among the plans or PPOs.
Numerous factors, such as type of plan, co-pay, co-insurance, deductible, out-of-pocket maximums and any limitations on coverage such as whether or not the hospital is a participating provider in the Medicare Choice plans network also will affect your financial responsibility to a hospital.
Begin by contacting your Medicare Choice plan or PPO to understand all of the factors affecting your financial responsibility.

IF YOU HAVE MEDICAID:

Medicaid pays hospitals in accordance with a set fee schedule that represents a discount from a hospital’s billed charges.
Generally, Medicaid recipients are not responsible for any portion of the bill.
Contact your local Medicaid office or visit http://www.ohca.state.ok.us/ .

IF YOU HAVE MEDICAID MANAGED CARE SOONERCARE OR CHIP:

Medicaid managed care plans and Children’s Health Insurance Program (CHIP) plans negotiate discounts with hospitals on behalf of the patients they represent. The discounts vary among the plans.
Numerous factors, such as type of plan, co-pays if applicable, out-of-pocket maximums and any limitations on coverage under your Medicaid managed care plan or CHIP also will affect your financial responsibility to a hospital.
Begin by contacting your Medicaid managed care plan or CHIP plan to understand all of the factors affecting your financial responsibility.

IF YOU ARE UNINSURED:

For patients who do not have insurance, hospitals typically offer discounts. Some discounts may be based on the patient’s income level and family size.
State law requires Oklahoma hospitals to establish a discount program for patients who have household income below 300% of the federal poverty guidelines and who are not eligible for or enrolled in private or public insurance plans providing hospital coverage.
You should contact the hospital’s business office for information on the hospitals policies and how to request a discount. In some cases, you may be asked to verify income or other assets to determine whether or not you qualify for full or partial financial assistance.