At Phoenix Children’s we are committed to making information about the cost of healthcare services readily available to our patient families so they can better anticipate and understand their financial responsibilities and make informed healthcare decisions. “Pricing Transparency” is the term used to describe initiatives in the healthcare industry to provide meaningful pricing information to consumers.
Legislative Support of Pricing Transparency in Healthcare
Effective January 1st, 2019 the Centers for Medicare & Medicaid Services (CMS) will require that each hospital operating within the United States shall for each year establish, update and make public a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act. To access this list, please click the link below.
In addition the Arizona State Legislature approved HB 2045 in 2013 which requires hospitals and healthcare providers with more than 50 beds to make available to the public, upon request, the Direct Pay Price for their 50 most used Diagnosis Related Group (DRG) codes. The Direct Pay Price is the price that Phoenix Children's charges for the identified service, regardless of the patient’s health insurance status, if the service is paid for directly, in full, either by a patient (directly or through a Health Savings Account) or by the patient’s employer (for instance, through a self-insured plan). Please click the links below titled Phoenix Children’s 50 Most Used Inpatient Diagnosis-related Group Codes and Phoenix Children Outpatient Services Codes to access this information.
Common Definitions of Hospital Billing Terms
All Patient Reﬁned Diagnosis Related Groups (APR-DRG) categories were created by 3MTM in a joint effort with the Children’s Hospital Association, to create consistency among children’s hospitals, allowing us to track outcomes as well as costs.
A patient is ﬁrst assigned to a base APR-DRG (e.g.: APR 139, Other Pneumonia) similar to the assignment of a Medicare-based MS-DRG. This assignment is based primarily on the patient diagnosis but takes into account several other factors as well.
The patient is then separately assigned two distinct subclasses: severity of illness (SOI) and risk of mortality (ROM). SOI is defined as the extent of organ system derangement or physical decompensation for a patient.
Each subclass has four possible assignment levels:
The SOI class provides a basis for evaluating hospital resource use or to establish patient care guidelines. Patients are assigned their SOI based on their specific diagnoses and procedures performed during their inpatient hospital stay. Patients with higher SOI (e.g. major or extreme) are more likely to consume greater health care resources and stay longer in hospitals than patients with lower SOI in the same DRG.
If you come to Phoenix Children’s and you have a medical emergency or are in labor, you have the right to receive, within the capabilities of Phoenix Children’s staff and facilities, an appropriate Medical Screening Examination, necessary stabilizing treatment (including treatment for an unborn child) and, if necessary, an appropriate transfer to another facility even if you cannot pay or do not have medical insurance.
What’s the cost for my child’s care?
Because every child is different, our Financial Counselors are happy to talk with you about your child’s individual needs. Upon request, they will work with you to provide a personalized estimate of charges in advance of care.
We’re here to help
Our commitment is to ensure you understand the financial assistance processes at Phoenix Children's. If you still have questions, please contact our Financial Counseling department at 602-933-2000.
Learn more about our Financial Assistance Policy.