Common Definitions

Here are some common terms you may encounter regarding hospital costs.

CHARGE – the dollar amount a provider sets for services; the charge can be different from the amount paid

COST – the definition of cost varies by the party incurring the expense:

  • For patients, cost is the amount you pay for health care services
  • For health care providers, cost is the expense (direct and indirect) incurred to deliver health care services to the patient
  • For insurers, cost is the amount payable to the provider (or reimbursable to the patient) for services rendered to the patient
  • For employers, cost is the expense related to providing health benefits (premiums or claims paid)

PRICE – the total amount a provider expects to be paid by payers and/or the patient for health care services

DEDUCTIBLE – the initial amount patients will have to pay before benefits are paid under an insurance policy

COPAYMENTS – the flat dollar amount a patient must pay for services as determined by their health insurance plan

OUT-OF-POCKET PAYMENT – the portion of total payment for medical services and treatment that a patient is responsible for, including copayments, coinsurance and deductibles.