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- Quality first
- Insurance coverage and price
- Get details
- Insurance codes: What you need to know
- Know the limitations of an estimate
- Some services are not covered
- Price estimates and information
- Terms to Know
- Uninsured discount
- Pricing – Quality data
- myFinancial options
Mosaic Life Care is dedicated to providing our patients with the most information possible so they are confident in the care they receive and the price they pay. This means being transparent with the quality and price of care.
To increase transparency, we are participating in the Missouri Hospital Association's (MHA's) project to deliver cost and quality data from our inpatient and emergency hospital services. This gives patients access to data that shows how Mosaic Life Care compares to other health-care organizations and state averages in terms of pricing, outcomes and quality of care.
At Mosaic Life Care, we are committed to providing the best and safest care. Creating an environment that is known for providing a high-quality, safe, patient-centered health care experience is our priority. There are a number of factors that should be considered when choosing a hospital or clinic - price and quality being the most important.
Mosaic Life Care is the proud recipient of numerous quality awards and recognitions, most notably the Malcolm Baldridge Award. As a member of the Mayo Clinic Care Network, Mosaic Life Care is one of a carefully chosen group of like-minded organizations that share a common commitment to improving the delivery of health care in their communities through high-quality, data driven, evidence-based medical care.
Insurance coverage and price
If you have health insurance, the amount you will pay for care will depend on your insurance plan. Insurance plan benefit packages will determine how much you pay and how much your health insurance plan will pay.
Understanding your benefits and what is covered is one of the most important things you can do because any services or supplies your insurance does not pay for will be billed directly to you.
You will also want to make sure Mosaic Life Care is in-network for your insurance coverage. If your insurance company says Mosaic Life Care is not in- network for your plan, you will want to find out how your out-of-pocket costs will be affected if you use an out-of-network doctor. The price you pay is usually lower for in-network doctors.
The best way to prepare ahead is to ask your doctor what the procedure they are scheduling for you is called and what Current Procedural Terminology (CPT) codes they think they will use for your care. Then, contact your insurance company and ask them if that procedure and the CPT codes associated with it will be covered under your plan. Also, ask them what your estimated out-of-pocket cost may be. Remember, there may be instances where an initial plan of care may have to vary based on need when the actual procedure takes place, so while we do our best to be accurate, things can change and additional CPT codes may be needed to get you the care you need. See a quick list below under "Get details."
Please remember, authorized and covered do not mean the same thing. An insurance company may authorize you to have a procedure done but that doesn't mean that they will pay for the service. You will want to make sure you ask what cost your insurance plan will cover.
Ask your health care team about the following details for your surgery/procedure:
- The technical name of the procedure you will be having
- The procedure and diagnosis codes (CPT & ICD-9 or ICD-10 codes)
- A list of tests you may need before the procedure
- How long your hospital stay is expected to be for this procedure if you will be hospitalized
- Follow-up care you will need, such as rehabilitation or therapy
Insurance codes: What you need to know
In health care, providers and health insurance plans use several types of codes to communicate with each other about payment. The codes are designed to make sure that billing and payment are correctly handled. To get a price estimate, you should have the following code information:
- ICD-9 or ICD-10 code. (International Classification of Diseases) These codes identify your health condition or diagnosis. For example, 250.0 means diabetes with no complications; 493.0 is the code for asthma.
- CPT code. (Current Procedural Terminology) These codes are numbers that are often used on medical bills to identify the charge for each service and procedure billed by a doctor to you or your insurance plan.
Know the limitations of an estimate
A price estimate from Mosaic Life Care will include the following information if you do NOT have insurance:
- The procedure codes used to prepare your estimate
- The median price and price range for the procedure estimated, based on historical data
- The total price for your facility fee and the portion of that price you are expected to pay, with the self-pay discount applied
If you have health insurance, a price estimate from Mosaic Life Care will include the following specific information:
- The procedure codes used to prepare your estimate
- The median price and price range for the procedure estimated, based on historical data
- The total price for your facility fee and the portion of that price you are expected to pay based on the insurance information available at the time the estimate is prepared
All estimates provided by Mosaic Life Care will be a best ESTIMATE based on the information available before the service. It is not a guarantee of what you will be charged. Please understand that in many cases, it is impossible to predict the final charges that will result because there are factors that may vary in your actual services – variations such as length of time spent in surgery or recovery; specific equipment, supplies and medications required; additional tests required by your physician; and/or any unusual special care or unexpected conditions or complications. If you have health insurance, your benefits will ultimately determine the amount you owe (including deductibles, co-payments, co-insurance and out-of-pocket maximums).
If you do not have insurance, you may be eligible for a payment plan or financial assistance.
Some services are not covered
You will be responsible for paying the full amount due for any health care service, procedure or products that are not covered by your health insurance plan. Examples include cosmetic surgery, fertility testing and services or procedures considered experimental by your health plan.
Generally, non-covered services do not count toward your annual out-of-pocket maximum under your health insurance plan. Check with your health insurance plan for more details.
Price estimates and information
It is our goal to provide you with information about all aspects of your care, including cost. Information about what your health care services may cost you is available based on your personal situation. We are committed to providing you this information in a way that is easy to access and understand.
If you have health insurance (including Medicare or Medicaid): It is best to reach out to your insurance provider for pricing information first. Major insurers now provide this cost information and they will have your specific plan information regarding coverage. If your insurance provider tells you services are not covered, Mosaic Life Care can provide you with an estimate for what your services may cost without insurance. Please see our information about persons who are uninsured (without insurance or coverage).
If you are uninsured (without insurance or coverage): Mosaic Life Care financial services will provide you with estimated costs for care and can review any payment plan options that may be available for you. Price estimates are for standard procedures without complications. If there are complications or other unforeseen circumstances, the price may be higher. Price estimates include only the hospital costs (facility fee) and do not include charges for professional fees. The facility fee includes routine services such as: a standard room, dietary and nursing services, minor medical and surgical supplies, medical and social services and the use of equipment and supplies such as gowns, water pitchers, Kleenex, oxygen tubing, etc. These items are not broken out individually but instead are bundled together under a ‘facility fee’. Professional fees include physician charges, lab, radiology, anesthesiology, drugs, etc.
Professional fees and facility fees will be billed separately and you may receive multiple statements.
For clinic visits, we are not able to give you an exact total cost of care prior to a visit as it depends on the kind, severity and number of problems you address with your doctor privately in the office visit. However, we can give you some general information and definitions.
The doctor and hospital will bill separately for the services provided. As a result, you will receive two (2) separate bills for services provided in the clinic that we expect you to pay - one from the doctor and one from the hospital.
For a copy of our current pricing model for procedures performed at the hospital and clinics, please visit the main campus of Mosaic Life Care at:
5325 Faraon St.
St. Joseph, MO 64506
You can review the Mosaic Life Care's Top 100 most Prevalent hospital visits as defined by Medicare at http://focusonhospitals.com/.
For services or procedures that you can schedule ahead of time (non-emergent), it is always helpful to get cost estimates so you can have an idea of what your costs may be. Procedures such as knee replacements, cosmetic surgeries, tonsillectomies, etc. are just a few examples of elective surgeries that give you the opportunity to financially plan ahead. To get a cost estimate, please call (816) 271-6640.
Price estimates from Mosaic Life Care, Northwest Medical Center and Mosaic Medical Center - Maryville only include the charges for the facility fee and will not include all services received during your care. The facility fee includes routine services such as: a standard room, dietary and nursing services, minor medical and surgical supplies, medical and social services and the use of equipment and supplies such as gowns, water pitchers, Kleenex, oxygen tubing, etc. These items are not broken out individually but instead are bundled together under a ‘facility fee’. Estimates do not include any professional fees (physicians, lab, radiology, anesthesiology, etc.).
Standard charges for Mosaic Life Care can be reviewed by picking up a copy of our current pricing model as noted above or by clicking here. Standard charges for Northwest Medical Center can be reviewed here. Standard charges for Mosaic Medical Center - Maryville can be reviewed here. The standard charges included in the links above are updated annually. These charges were last updated January 1, 2019.
Terms to Know
- New patient: person that has not been seen in the doctor’s office for 3 years or who has never been seen in that clinic practice group (e.g. Family Medicine).
- Established patient: person that has been seen in the doctor’s office or that practice group within the past 3 years.
Note: The charges are different depending on if you are new or established patient.
- Facility fee: routine services such as: a standard room, dietary and nursing services, minor medical and surgical supplies, medical and social services and the use of equipment and supplies such as gowns, water pitchers, Kleenex, oxygen tubing, etc. are not broken out individually but instead are bundled together under a ‘facility fee’.
- CPT code: unique number assigned to specific medical service and procedure. Learn more about CPT codes.
- Physician (doctor) charge: is the charge of the health professional that cared for you.
- Professional fees: physicians and professional providers bill separately for the care they provide (ex. physician labs, radiology, anesthesiology, etc.). Billing companies who bill professional fees for services received at Mosaic Life Care can be found here.
- Standard charge: is the charge by Mosaic Life Care for facility, support testing and costs for supplies. Standard charges do not include all charges you may be billed, costs associated with professional services are not included in the standard charge.
- Combined charge: is the total of doctor fees and hospital fees.
- Deposit: the amount we ask that you pay as a deposit toward the total charges for your care, requested at the time of the visit before the visit begins.
- Uninsured discount: If you are uninsured (have no health insurance or third-party liability), you will be eligible for a self-pay discount of 15% from your total charges if paid in full within 30 days of your billed date.
If you are uninsured (have no health insurance or third-party liability), you will be eligible for a self-pay discount of 15% from your total charges if paid in full within 30 days of your billed date.
Price and Quality Data
Before you browse the data, here’s some information that will help you understand what it all means to you as a patient.
Pricing and quality data are based on inpatient and emergency department claims from 2015.
- Pricing data does not include professional services (additional costs such as doctor fees, radiologist fees, etc.).
- Pricing data does not reflect your out-of-pocket expenses. Every patient’s situation and treatment plan is unique to his or her needs, and insurance coverage varies from person to person. These prices may not be what you are billed.
- To have a better understanding of what your out-of-pocket expenses will be for a service or procedure at Mosaic Life Care at St. Joseph, Medical Center, please contact your insurance provider first, then Mosaic Life Care’s pre-registration office at (816) 271-6579 or (800) 447-6827. If you are insured, please have your coverage information available when calling.
If you have questions or concerns about the cost of your medical services, please contact us to learn more about our Financial Assistance Policy. We are committed to helping you find a simple, affordable way to address your medical expenses, and we will work with you to provide solutions that fit your unique needs. To learn more, call (844) 261-7266.