Atrium Health Floyd is committed to helping patients, in partnership with their care team, make informed decisions about their health care. This includes helping patients understand the cost of their care, as well as financial assistance that may be available.
There are several items that go into determining your total out-of-pocket cost for your health care. These include:
- Do you have insurance?
- What type of coverage do you have?
- Do you have a secondary or supplemental insurance?
- Is the care being provided a covered service under your insurance?
- Is the service authorized by your insurance carrier?
You play a major role in making sure that your health insurance will cover the services received.
You should always ask your insurance carrier if the procedure or service your health care provider has ordered is a “covered service.” If it is covered, check to see if that service requires an authorization or precertification.
If it does require an authorization or precertification, check with your provider and/or health care facility to make sure the required authorization or precertification has been obtained.
Get an Estimate
The way to get the most accurate estimate of what you would owe for your procedure or service is to contact a representative from the health care facility. Our representatives can help you get an estimate of what you would owe based on the information you provide. Call Atrium Health Floyd at
Information Needed for Estimate
When requesting a price estimate, we will need several specific items to calculate the most accurate estimate possible. These include the following:
Patient date of birth
Insurance name and subscriber number (available on your insurance card)
All procedures to be performed and diagnosis (available from your provider). Having all procedures that will be performed will ensure a more accurate estimate of your out of pocket responsibility.
We will be able to give you an estimate based on your individual insurance coverage and procedures scheduled to be performed.
An important reminder, this estimate is for hospital charges only. Our estimate does not include your physician, the anesthesiologist, pathologist, radiologist, or other specialist involved in your care. You will receive bills directly from those providers if they perform any services for your care. The estimate does not cover any unforeseen costs related to your care, such as medical complications, additional services that were performed that were unknown at the time of the estimate, or any special accommodations or considerations that were necessary.
Where can you view Standard Charges and Shoppable Items?
In compliance with federal regulation, Atrium Health Floyd provides a list of standard charges for each of its facilities in a machine-readable format. The public may view the Centers for Medicare and Medicaid Services (CMS) Hospital Pricing Transparency requirements at the following CMS webpage:
The charge lists posted on this website are accurate, with applicable disclaimers, as of the date indicated within each facility/tab file header. CMS requires hospitals to update annually. Therefore, ongoing additions and changes made after the date indicated may not be reflected in the posted files until the next update.
The list charge of a hospital service is not equivalent to the actual amount paid by governmental or commercial insurance companies; accordingly, each patient's financial responsibility may vary. The amount a patient pays is based on many factors, including health insurance, benefit plans and other applicable discounts, as well as the services provided based on each patient's unique needs. It is unlikely that your final bill will exactly match the prices listed and may serve only as an estimate of the final cost.
Atrium Health Floyd reviews its hospital charges annually to ensure they accurately reflect the high-quality care we seek to provide. In some cases, our charges are different from other providers when we offer a differing level of care or unique clinical expertise.
Atrium Health Floyd works with patients, providers and partners to lower the cost of care through wellness programs, disease management and quality care.
Understanding Pricing Guide for more details and a quick overview standard charges.
View Standard Charges and Shoppable Items (as applicable by date indicated) by clicking the facility name:
Calling your insurance company is always recommended if you are considering an elective procedure and want to get a general idea of your out-of-pocket costs. Your insurer can help you understand how your coverages and deductibles work as well as your current payment history as an essential first step.
What if my service is not covered by insurance or I don't have any insurance?
Private pay is when you, as the patient, do not have any insurance coverage, or your insurance does not cover the service or procedure (“non-covered service"). In either case, you are responsible for payment of the bill. We offer two discounts in these cases.
- For Atrium Health Floyd hospital care/services: The self-pay discount is 50%.
- For Atrium Health Floyd physician charges: The self-pay discount is 40%.
There are no discounts for prompt pay.
If you are interested in a payment plan for your services or need information on financial assistance policies and programs, call the appropriate number:
Learn more about our financial assistance policies:
What are claims, bills and reimbursement?
After you have been discharged your insurance company will be sent a claim for your services. There are times that once the carrier receives the claim, they may reach out to you for some additional information before they make payment. For example, if they believe this could be due to an accident, they will want to gather information about the accident and any other possible coverage. It is very important to respond in a timely manner. Not doing so could result in your claim being denied leaving you responsible.
It can take 30 to 60 days for an insurance company to pay the claim once they have all the information they need to process the claim. Once the facility is paid by the insurance company, you will be sent a statement for any balance owed by you. If you paid any amounts up front, that will be reflected in your statement. If by chance the estimate was more than you owe, and you did pay up front, we will process a refund to you. Unpaid claims will be referred to collections.
If you are interested in a payment plan or need financial assistance for the care you received, call the appropriate office:
How do insurance carriers pay the claim for a covered service?
Insurance reimbursement depends on your payor source (insurance company, Government, or private payment) and your individual insurance plan.
Government payors typically pay on a pre-determined fixed schedule, and this is dictated to the hospital by the Government entity; it is not negotiated. Medicare, for instance, pays inpatient hospital stays on a fixed payment schedule based on Diagnosis Related Group (DRG) regardless of what the hospital charges. DRGs are groups of similar services that CMS has grouped into specific categories (DRGs) based on the diagnosis or service.
The patient is responsible for an in-patient deductible. If the patient has a supplement or second insurance, that insurance may cover part or all the remaining deductible amount depending on the plan.
Outpatient services are paid on a separate schedule from inpatient services. For outpatient services, the patient is responsible for both a deductible and co-insurance. Again, if the patient has a supplement, the other insurance may pay part of the co-insurance.
View the average charges by DRG:
Medicare Advantage plans or Medicare Replacement plans tend to reimburse more like commercial (non-government insurance plans) payors and have many restrictions on coverage, so it is very important to ensure your procedure or service is a covered service and that authorization and/or pre-certification has been given by the plan. These plans may also have restrictions on what hospitals and physicians are “in network” (meaning they will cover the service or procedure at that facility or with that physician).
Commercial payors contract with hospitals to care for their customers. Hospitals are paid the insurance company’s contract rate, which is significantly less that the amount listed in the chargemaster. The insurance company’s contract rate, not the chargemaster, is the basis for determining the patient’s actual out-of-pocket costs.
For example, a hospital may charge $1,000 for a specific service, while the insurer’s contracted rate may be $700 (also known as the allowable amount). If the patient’s insurance plan indicates the patient is responsible for a 20% co-insurance, the patient would owe $140 ($700 x 20%). If the patient has a secondary insurance, the secondary coverage may pick up at least part of the deductible, co-payment or co-insurance.
Are charges the same for every patient?
Each service or item charged is the same charge amount. However, each person and each procedure may involve many differences and therefore the total charges could vary between two people having the same procedure. For example, the causes for a different total charge for a surgical procedure would include, but not limited to, the following:
- How long the procedure and recovery take
- The medications that are required during and after your service
- If there are complications that must be addressed in your care
- Additional treatments that may be required
- Each person's underlying health conditions