STANDARD SERVICES PRICE GUIDE
Understanding Hospital Charges, Payments, and Pricing Transparency
It is important to understand that a hospital “charge” is not the same as the amount a hospital expects to be paid. A charge represents the amount billed for a service; however, in most cases, hospitals receive significantly less than the billed charge.
Hospital charges are based on the type of care provided and may vary from patient to patient—even for the same service. Differences in charges often reflect individual medical needs, such as complications or variations in treatment related to a patient’s condition.
While the hospital’s standard charges are consistent across patients, the actual charges for a specific patient may differ from the listed prices due to a combination of clinical and treatment-related factors.
For additional guidance, the Healthcare Financial Management Association offers a helpful resource titled “Understanding Healthcare Prices: A Consumer Guide.” This booklet explains how healthcare pricing works, where to find answers to pricing questions, how to compare costs among providers, and how to better manage out-of-pocket expenses.
UNDERSTANDING HEALTHCARE PRICES: A CONSUMERS GUIDE
STANDARD CHARGES AND SHOPPABLE SERVICE LINKS:
Download our machine-readable file containing standard charges for all items and services here
MountainView Shoppable Services (xlsx)
CMS Price Transparency Guide
Your Rights and Protections Against Surprise Medical Bills
When you receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing. These protections ensure that you are only billed what you would normally pay in-network—such as your plan’s copay, coinsurance, or deductible—and not the full out-of-network cost.
Understanding “Balance Billing” (or “Surprise Billing”)
When you visit a doctor or health care facility, you usually pay out-of-pocket costs that your insurance plan allows. But if you are treated by a provider who is not in your plan’s network, they may bill you for more than your plan covers. This is called balance billing.
Balance billing is most common when:
- You receive emergency care and cannot choose your providers
- You visit an in-network facility but are unknowingly treated by an out-of-network specialist
These unexpected bills are called surprise medical bills, and they can be very costly.
When You’re Protected
1. Emergency Services
If you have a medical emergency and receive care from an out-of-network provider or facility, you can’t be charged more than your in-network rate.
This includes care received after you are stabilized, unless:
- You give written consent, and
- You agree to give up your protection from balance billing.
2. Certain Services at In-Network Hospitals or Ambulatory Surgical Centers
You are also protected if you receive care at an in-network hospital or surgical center but are treated by an out-of-network provider.
This applies to services like:
- Emergency medicine
- Anesthesia
- Radiology
- Pathology
- Neonatology
- Laboratory services
- Assistant surgeons
- Hospitalists and intensivists
These providers cannot balance bill you, and they are not allowed to ask you to waive your protections.
If you receive care outside of these categories (like physical therapy or specialty consultations) at an in-network facility, the provider may balance bill you only if:
- They notify you in advance, and
- You agree in writing to be billed out-of-network.
Know Your Rights
When you choose a provider or facility within your health plan’s network, you’re protected from unexpected charges. Even when balance billing isn’t allowed, you’re still entitled to the following protections:
- You’ll only be responsible for your usual cost-sharing—such as copayments, coinsurance, and deductibles—just as you would with in-network care.
- Your health plan will pay the rest directly to out-of-network providers or facilities.
Your Health Plan Must Also
- Cover emergency services without requiring prior authorization.
- Pay for emergency care from out-of-network providers.
- Base your cost-sharing (the portion you owe) on in-network rates and list these amounts in your Explanation of Benefits (EOB).
- Apply your payments toward your in-network deductible and out-of-pocket maximum, even when the care is out-of-network in an emergency or protected situation.
If You Think You’ve Been Wrongfully Billed:
- Call the federal No Surprises Help Desk at 1-800-985-3059
- Visit: www.cms.gov/nosurprises/consumers
For Questions About a Good Faith Estimate:
- Visit: www.cms.gov/nosurprises/consumers
- Email: FederalPPDRQuestions@cms.hhs.gov
- Or call: 1-800-985-3059
For Questions About a Good Faith Estimate:
This information complies with CMS Price Transparency regulations. This information is a base set of charges which might be utilized for patients receiving services at Mountain View Hospital. The exact charges for individual patients could be slightly different, since treatment is individualized by patient to best treat the diagnosis, presenting signs and symptoms
If you have any questions about these documents, please Contact Us.
The Centers for Medicare & Medicaid Services (CMS) requires hospitals to publicly post their standard charges in a machine-readable format on the internet. This requirement is intended to give patients greater access to pricing information and promote transparency in healthcare costs.
In accordance with the CMS Hospital Price Transparency Final Rule, the first button below links to a machine-readable file containing the standard charges for the hospital’s services. The second button links to a consumer-friendly list of shoppable services, including the negotiated rates with individual payors at MountainView Behavioral Hospital.
Disclaimer: A patient’s actual charges and out-of-pocket costs depend on the specific services received and the terms of their insurance coverage. Because these factors vary, the pricing information provided does not represent a guarantee or an estimate of the amount a patient may be responsible for paying.