Prices are as of January 1, 2023 and are subject to change.

• Beginning  January 1, 2019, the U.S. Department of Health & Human Services and Centers for Medicare & Medicaid Services are requiring hospitals and health systems to post their “current, standard charges.”

• Hospital charges are the amount a hospital bills for a service. For most patients that are covered by insurance, hospitals are reimbursed at a level well below charges. Patients covered by commercial insurance products have negotiated rates (for payments) with hospitals. Patients covered by Medicare, Medicare Advantage, or Medicaid and Prepaid health programs have hospital reimbursement rates determined by federal and state governments. If you reside in the State of Minnesota and are uninsured, you will receive a discount on your total bill in accordance with the MN Attorney General agreement.

• When a patient has the opportunity to shop for medical services, he or she should contact his or her own insurance carrier to understand which costs will be covered and which will be the patient’s responsibility.

• Patients can contact our Price estimate team at the hospital directly for any pricing requests. Please call (218)283-5414.

CMS Hospital Price Transparency January 1, 2023

Hospital-based clinic fee disclosure

The Rainy Lake Specialty and Orthopedic Clinic areas are hospital-based clinics of International Falls Memorial Hospital Association and the office visit/procedures charges are separated into a facility fee and professional fee depending on your type of insurance coverage.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in‑network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact Website: https://www.cms.gov/nosurprises/consumers.

Phone number for information and complaints: 1-800-985-3059.

In addition to federal law, you may have protections available to you through state law. If state law protection is available, contact information will be included on your Explanation of Benefits (EOB) for any applicable services.

COVID TESTING PRICES

How much does a lab test for COVID-19 cost?

The diagnostic test costs $169.95. This is a test sent to our reference lab that utilizes reverse transcriptase-PCR and currently has a turn-around time of two business days.
The in-house test is the Abbott IDNOW COVID19 test and has a turn-around time of 30 minutes. This has strict criteria for patients to qualify that is designed protect our most vulnerable populations. It utilizes isothermal amplification and costs $216.30
An order is required by a practitioner. Depending on the location of your services, a collection fee of $26.01 may be charged.

This amount doesn’t reflect what your health insurance might be charged or your out-of-pocket costs. This information is subject to change and does not reflect additional charges that you could incur at the time of service.
Under the Cares Act, health insurers and employers must reimburse for all COVID-19 testing based on the price you see listed here unless they have already negotiated a rate or negotiate a new rate. Please contact your insurance company about your out-of-pocket expenses.
How much does an antibody test for COVID-19 cost?
The IgG antibody test costs $145.95 and utilizes the Abbott Architect SARS-CoV-2 IgG test performed with chemiluminescent microparticle immunoassay (CMIA). The antibody test is not used to diagnose a current infection with the COVID-19 virus but helps determine if you have had a previous infection.
An order is required by a practitioner.
This amount doesn’t reflect what your health insurance might be charged or your out-of-pocket expenses. This information is subject to change and does not reflect additional charges that you could incur at the time of service.
The antibody test is not used to diagnose a current infection with the COVID-19 virus but helps determine if you have had a previous infection.
Under the Cares Act, health insurers and employers must reimburse for all COVID-19 testing based on the price you see listed here unless they have already negotiated a rate or negotiate a new rate. Please contact your insurance company about your out-of-pocket expenses