Understanding Your Insurance
Baffled by premiums, deductibles and out-of-pocket maximums? We know that medical bills and health insurance claims can be confusing.
Watch an overview of how health insurance works.
As part of Ochsner’s continued commitment to improving our price transparency for consumers and empowering patients through better access to price information, we are now offering the following options:
Create Your Self Service Estimate through your MyOchsner account
If you do not have a MyOchsner, sign up online
Request Your Personalized Estimate
Common Insurance Terms
These terms can help you with understanding your out-of-pocket costs for healthcare services that are not covered by your insurance benefits.
- Deductible is the dollar amount you must pay toward your healthcare expenses before your benefits plan begins to pay its share.
- Copay (or Copayment) is the fixed dollar amount of healthcare costs for which you are responsible. This is usually a flat dollar amount based on a particular service.
- Coinsurance is your share of healthcare costs that you are responsible for paying. This is paid after the deductible is met for the year.
- Out-of-Pocket Maximum is the most you will have to pay on your own for your healthcare. This includes your coinsurance and deductible. Afterwards, your insurance company will cover 100% of the covered costs.
How is Insurance Applied to Healthcare Services?
For example, if you have a health plan with a $1000 deductible, 20% coinsurance, and a $6000 out-of-pocket maximum. If you had a $50,000 medical bill, you can expect the following to happen:
- Deductible: Your $1000 deductible is paid first. That leaves $5000 before reaching your out-of-pocket maximum.
- Copay (or Copayment): This is the fixed dollar amount of healthcare costs for which you are responsible. This is usually a flat dollar amount based on a particular service.
- Coinsurance: Based on 20% coinsurance, you pay $1000 for every $4000 paid by your insurance company. For the next $25,000 in covered medical expenses, you pay $5000 and your insurance company pays $20,000.
- Out-of-Pocket Maximum: After you’ve paid your $1000 deductible and $5000 in coinsurance, you’ve reached your $6000 out-of-pocket maximum.
Call us directly at 504-703-2773 or 855-241-9351 if you have any questions about the pricing and billing estimates.
Please note, all billing estimates are based on information provided by a prospective patient and do not include, among other things, any unforeseen complications, additional tests or procedures, and non-hospital related charges, any of which may increase the ultimate cost of the services provided. A final bill for services rendered at Ochsner Health System may differ from the information provided by this website, and Ochsner Health System shall not be liable for any differences.
Click here to view our Patient Financial Responsibility Estimate Policy.
Answers to Questions about Billing Estimates
What is usually included in a service estimate?
Estimates are based on what specific procedures normally cost, including doctor and facility fees and supplies. Actual costs may vary because there is no way to predict exactly what services will be needed. Included in the estimates are anticipated fees for items such as room and board, operating rooms, anesthesia, surgeons and when applicable, assistant surgeons. Charges such as pre-surgical consultations, tests and other supplies are not included in the estimate.
What services are included in my estimate?
The estimate includes estimated room and board (for inpatients), supplies, nursing care, equipment use, nutritional services, and any services handled by the staff of the hospital within the walls of the hospital. It does not include services listed below:
- Physicians providing you with services related to your hospital stay or visit will bill you separately. This can include fees related to specialists, anesthesiologists, pathologists, and radiologists.
I have more questions about surgical estimates. Who can I call?
- You may request additional information from the Patient Financial Services department which is located on the first floor of the Ochsner Medical Center or you may call 504-703-2773 or 855-241-9351.
If I have health insurance, how much will I owe?
The amount you owe depends on your insurance plan. Coverage benefits can differ greatly from plan to plan. If you have health insurance, you should contact your insurance company directly to determine what your coverage will be. You may be asked to provide a procedure code, which can be obtained from your physician's office.
When I call for an estimate, what information do I need to have available?
Before completing this form, contact your physician's office to get the best description possible of the service that you need and its procedure code. Then, if you have insurance, contact your insurance company and confirm that the services required are "covered services" under your specific plan. If they are “not covered", then you would be considered "uninsured" for these services. When you complete the inquiry form, please have the following information so we may provide you with our best estimate of your financial responsibility:
- Description of services needed - Include as much information as possible about the specific services needed as described by your physician.
- Type of services needed - For example, will you be admitted to the hospital as an inpatient overnight, or expect to be treated on an outpatient basis.
- Physician/Specialist Name - For example, if you are having surgery, enter the surgeon's name.
- If you have insurance, include the following:
- Your current insurance card - Please provide the name of insurance company, type of policy (e.g. HMO, PPO, POS, Indemnity), policy holder's name, group name and number, policy number, and insurance company phone number.
- Policy holder's personal information
Select a facility to view hospital charges
- Ochsner Medical Center - Jefferson Highway
- Ochsner Medical Center - Kenner
- Leonard J. Chabert Medical Center
- Ochsner Medical Center - Hancock
- Ochsner Medical Center - Baton Rouge
- St. Charles Parish Hospital
- Ochsner Medical Center - North Shore
- Ochsner Medical Center - West Bank Campus
- St. Bernard Parish Hospital
- Ochsner St. Anne Hospital
- Ochsner Health Center Locations