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Price Transparency
Beth Israel Lahey Health and Lahey Hospital & Medical Center (LHMC) are committed to price transparency as part of our mission to provide high-quality, affordable care while complying with Federal laws requiring clear and helpful price information be made available to the public.
When you know what you can expect to pay for common health services, you can manage your health care dollars more effectively. Beth Israel Lahey Health offers an interactive online treatment cost calculator that gives you estimates of your out-of-pocket costs for common exams, tests and procedures.
Current Patients Calculator Prospective Patients Calculator
Variation in health insurance plans and other benefits make it difficult for hospitals to provide specific cost information about more complex care without access to detailed information about a patient’s health insurance coverage.
The Centers for Medicare and Medicaid Services (CMS)-required hospital charge data is also available in the treatment cost calculator. Find more information about this required file in the Price Transparency FAQ section.
Please note: Because of the size of the file, you may need special computer software/speed to open the CMS-required hospital charge data file.
Frequently Asked Questions
How is pricing information shared?
The Centers for Medicare and Medicaid Services (CMS) requires hospitals to provide clear, accessible pricing information about the items and services they provide in two ways:
- Provide information about the rates negotiated with insurance companies for all services and items offered by our hospitals. This information is not an estimate of the costs that you are responsible for paying. The CMS-required hospital charge data files might not be the best tool for patients and families who are comparison shopping between hospitals and health systems for shoppable services. You can find our CMS-required hospital charge data in the treatment cost calculator. Please note: Because of the size of the files, you may need special computer software/speed to open the files.
- Show shoppable services in a consumer-friendly way. CMS defines shoppable services as those that can be scheduled in advance. Hospitals are required to make available a minimum of 300 shoppable services, including a pre-set list of 72 procedures.
Beth Israel Lahey Health offers a consumer-friendly online calculator to estimate the cost of out-of-pocket expenses for common exams, procedures, and tests, including the 300 shoppable services. Existing patients, can access the estimates calculator here. If you are a prospective patient, access the calculator here.
For more information about hospital costs, visit CompareCare, a website created by the Commonwealth for consumers to compare costs of medical procedures and quality metrics across Massachusetts.
How is the CMS-required hospital charge data file used?
As required by the federal government, we publish information about all services and items offered by our hospitals, plus:
- Rates negotiated with insurance companies
- Individual gross charge amounts
These amounts are almost never billed to you or received as payment by a hospital. The amounts are billed to an insurance company, Medicare, or MassHealth. These payers then apply their reimbursement terms or contracted rates to the services billed which is why these rates are also not generally reflective of your out-of-pocket expenses.
If you owe a co-payment, co-insurance, or deductible, these too are most often not based on chargemaster amounts, but are based on the payment terms determined by your insurer or government program.
What isn't included in the CMS-required charge data file and online tool?
The CMS-required charge data file for the hospitals within Beth Israel Lahey Health do not include services provided by physicians and/or other providers who are not employed by the hospital. A partial list of the healthcare providers who may bill you separately include:
- Your personal physician and/or provider
- The surgeon who performs your procedure
- The anesthesiologist
- The radiologist who reads your x-rays or other imaging studies such as an MRI or CT scan
- Other physicians and/or providers who may have been asked to provide a consultation during you time in the hospital
Are charges the same for every patient?
Yes, there is one list of charges used by the hospital. Your individual charges will vary for reasons including:
- Differences in the specific services received
- How long it takes to perform the service or how long it takes you to recover in the hospital
- Whether the service you receive is more or less difficult than expected
- The kinds of medication or supplies you require
- Whether you experience complications or require additional treatment
Is financial assistance available to my family and me?
Yes, Beth Israel Lahey Health recognizes that not all patients have the resources to pay for care they need, and we are committed to providing assistance and financial counseling. If you have limited or no insurance coverage, you may qualify for help through MassHealth, Commonwealth Care or Health Safety Net. Check our financial assistance policy for more information.
Certain physicians are not covered under our financial assistance policies. A financial counselor can provide more information.
What is surprise/balance billing protection?
When you get emergency care or are treated by an out-of-network provider at an in-network hospital, you are protected from balance billing (also called surprise billing). In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible. You have rights and protections against surprise medical bills.
