Defining Price Transparency at Hennepin Healthcare
Defining the Cost of Care at Hennepin Healthcare
Bundled Charges/Services: Charges that are grouped together, including multiple services. For example, a knee replacement will include the facility fee (hospital stay), anesthesiology charges, physician fee, pre-operative clearance, and supplies.
Claim (insurance): A formal request for reimbursement to an insurance company for medical services. A claim can make up several charges, this is the bill we send to the insurance company at negotiated rates.
Copay: A fixed out of pocket amount set by the insurance plan which is paid by the insured party, usually prior to a visit.
Coinsurance: An out of pocket percentage set by the insurance plan where the percentage of the claim is paid by the insured party.
CPT: Current Procedural Terminology (CPT) is a medical coding set used to identify/categorize medical, surgical and diagnostic procedures.
Deductible: An amount of money set by an insurance plan that must be paid by the insured party before insurance benefits will start paying on claims.
De-identified minimum negotiated rate: The lowest negotiated charge rate.
De-identified maximum negotiated rate: The highest negotiated charge rate.
Discounted cash price: The discounted amount charged to self pay patients.
Estimate: An approximation of the cost of healthcare services.
Facility Fee: The price the hospital sets for its portion of services. This could include certain supplies, room use, utilities, equipment, ancillary staff, and does not include professional provider charges.
Gross Charges: The list price. Contractual insurance rates or discounts are not included in this amount.
Guarantor: The person or party responsible for payment of services.
Hospital-Based Fee: the nationally-recognized billing process for services rendered in a hospital outpatient clinic or location. The location does not need to be at a hospital location.
Hospital-Based Location: Hospital-based care is care provided at a location that is clinically integrated with a hospital. This includes any of the clinics located on the downtown Hennepin Healthcare campus. Insurance may pay differently for services in these locations as opposed to a Freestanding Location such as: BeWell Clinic, North Loop Clinic, Richfield Clinic, Golden Valley Clinic, Saint Anthony Village Clinic.
Facility Fee: The price the hospital sets for its services.
Fee Schedule: A list of set fees for gross charges.
Freestanding Location: Locations not licensed as Hospital Based. This includes Hennepin Healthcare’s BeWell, North Loop, Richfield, Golden Valley, and Saint Anthony clinics.
Net Charges: The amount charged for services including contractual insurance rates or discounts. This is the amount seen on a claim or statement.
Non-Covered Services: Services not covered or paid for by insurance.
Out of Pocket Cost: The guarantor or insured parties expenses that are not covered by insurance. This includes the deductible, copays, coinsurance and any costs for non-covered services.
Payer-specific negotiated charge: charges that the hospital has negotiated with third-party payers for an item or service.
Physician Fee: The charge for a provider’s professional services.
Prior Authorization: An insurance company’s pre-service approval that they will help pay for authorized services.
Provider: The physician or other advanced practitioners who provide professional services to the patient.
Statement: Otherwise known as a bill. This is what is sent to a guarantor for any outstanding balance.
Discounts are available to patients without insurance. The following are our standard self-pay discounts set by the Attorney General:
- Provider-Based: 57%
(excludes freestanding locations: North Loop Clinic, Richfield Clinic, Golden Valley Clinic, Saint Anthony Village Clinic)
- Freestanding Locations: 36%
(North Loop Clinic, Richfield Clinic, Golden Valley Clinic, Saint Anthony Village Clinic)
- International Patients: 10%
Hennepin Charity Care: Refer to the Financial Assistance page for more information.
Note: Not all services, such as cosmetic services, include a discount for self-pay patients.
Contact Us Today
If you don’t see the information you want or need help in understanding the cost of your care, we can assist. Our price estimate team is prepared to provide a price estimate. Ask for help at any time, but it is best to seek assistance before the time of service. The Price Estimate department can be reached at:
This tool lets patients know what their out-of-pocket costs are for over 300 common services. This service is being offered to meet the January 1st, 2021 CMS Price Transparency requirements. Improved Price Transparency tools give our patients a better opportunity to understand what their cost of care will be.
Price estimates are based on historical data of like or similar procedures and current insurance coverage. While we make every effort to provide accurate estimates, please note that these are only estimates and actual charges may vary depending on specific circumstances. Estimates are calculated assuming HHS is in-network with your insurance plan. Non-covered services or services needing prior authorization are not considered in our estimates. Our online price estimates reflect prices from Hennepin Healthcare hospital-based locations only. The following clinic prices are excluded from our online estimates:
- Golden Valley Clinic
- Richfield Clinic
- North Loop Clinic
- Saint Anthony Clinic
Please note these estimates are based on the patient’s mailing address being listed as in the United States.
State Mandated Price Transparency
Clinic Price Transparency: Effective 7/1/19, Hennepin Healthcare will post our most common 25 services in our primary care (pediatrics, internal medicine, family medicine, OB/GYN) clinics that are over $25. This information can also be accessed via the MN Pricing Information. These posters include the price charged by Hennepin Healthcare in provider-based and freestanding locations. It also includes the reimbursement rates for Medicaid, Medicare, and commercial insurance. The amounts posted do not reflect the amount individual patients or their health insurance plan will owe for the services listed. For specific information about the amount owed, patients will need to contact their insurance company.
Hospital Price Transparency: Effective 1/1/21, if you are a self-pay patient or are covered under an individual or fully insured health plan, Minnesota hospitals are required under law to provide you with an itemized description of billed charges in plain language within 30 days of discharge. To access your itemized description of billed charges please login to your MyChart account or sign up for MyChart. If you would like a paper copy of your itemized bill please contact Customer Service at 1-800-495-4915.
- The Minnesota Legislature passed a law in 2019 that requires hospitals to provide within 30 days of discharge an itemized description of billed charges for medical services and goods the patient received during the hospital stay. This law came into effect on Jan. 1, 2021.
- This itemized description of billed charges is not a bill.
- For more information about this disclosure of hospital charges, please contact Customer Service at 1-800-495-4915.
- For specific information about the type of insurance coverage you have, please contact your insurer.
2024 Price Transparency – Standard Charges
Under the CMS Pricing Transparency rule, Hennepin Healthcare offers a machine-readable file of our standard charges for all items and services. This machine-readable file displays the complete list of Hennepin Healthcare’s Standard Charges, which include: gross charges, payer-specific negotiated charges, minimum, and maximum negotiated charges, and discounted cash prices.
- The available list of standard charges is not a true estimate of your out-of-pocket costs for services at 伟德体育app
- The Machine-Readable File displays the individual line-item standard charge for each particular item or service. It is not intended to reflect the diagnosis, its severity, or the cost of any resulting or corresponding treatment recommended by physicians to treat a condition or diagnosis.
- When a patient is seen for multiple services, multiple fees can be associated with that visit. We are only displaying the standard charges associated with each unique item or service if applicable.
- In situations where there is no applicable information, a -1 will display.
- It is important to contact your insurance company to determine the out-of-pocket costs and verify if there is a need for prior authorization. Your insurance coverage determines your co-payment, co-insurance percentage, and annual deductible.
This information was last updated January 2024.
The following document is in CSV format. Due to file size, this document can be referenced with appropriate tools to accommodate file and format.
Download the Hennepin Healthcare Machine-Readable File (File size: 489MB).