Getting a Price Estimate

How Much Will My Care Cost?

This question is top-of-mind for many of our patients. Being transparent about the cost of your care is just one way Agnesian HealthCare is improving health care. Here are some resources to help you make a more informed decision about your care and to help you better understand any out-of-pocket costs you may incur.

We know that navigating health care costs can be confusing, so we invite you to call or e-mail us for a personalized price estimate. And if you need help with financing your care, we can start that conversation too. Agnesian HealthCare is committed to making health care better for you.


Request an Estimate

Hospital Pricing (St. Agnes Hospital, Waupun Memorial Hospital, Ripon Medical Center) – (920) 926-4793

Fond du Lac Regional Clinic Pricing (all Clinic Locations) – (920) 926-8340

When calling, please be prepared to provide the following information to ensure a quicker response time:

  1. Patient name, date of birth and contact information
  2. Patient insurance information
  3. Name of Physician ordering test/procedure
  4. CPT code(s)* or description of service(s) to be performed

If you would like to complete a form request for your price estimates, please follow the instructions below.

  • Please download and fill out the price estimate form HERE for Fond du Lac Regional Clinic services and e-mail to: agn-clinic.estimates@ssmhealth.com
  • Please download and fill out the price estimate form HERE for Hospital services and email to: agn-hospital.estimates@ssmhealth.com

*A coding system, defined in the publication Current Procedural Terminology, for medical procedures that allows for compatibility in pricing, billing and utilization review. If you do not have the CPT code for your procedure, our customer care representatives can provide this information with an exact description of the service. If you are unable to provide a description, you can obtain this information by contacting your physician’s office.


Items affecting your out-of-pocket expenses:

Deductible

  • The amount of money you must pay annually before your health insurance plan begins to pay for other medical expenses.

Co-Insurance

  • A cost-sharing requirement in which you are responsible for paying a certain percentage of the cost and the insurance company is responsible for the remaining percentage of the covered medical expenses after your deductible is met.

Co-Payment

  • Also known as a co-pay, this refers to a specific flat fee for each health service.

Items impacting the accuracy of the estimation of liability:

  • Accuracy of CPT(s)
  • Additional testing ordered
  • Patient remaining for observation/inpatient stay after a procedure
  • Cost/quantity of medications
  • Changes in patient deductible due to timing of insurance claims processing

Note: All estimates are an approximate amount of your out-of-pocket hospital and clinic billing expenses. This does not include any estimation for professional services provided by non-Agnesian providers (Radiologists, Pathologists, etc.). If your deductible has not been met, the estimate reflects the remaining deductible at the time the estimate was processed. If you have detailed questions about how your insurance carrier will process your claim, please contact your insurance carrier. Any estimation of liability is not considered a guarantee of benefits (or coverage of the test under your specific insurance plan).

The federal government requires each hospital to post on its website a list of its standard charges for each inpatient and outpatient service and item provided by the hospital. Each hospital is also required to make available their standard (median) charge for diagnosis-related groups (DRGs) which are used to bill for inpatient hospitalization services. The published price transparency spreadsheet is available HERE and the DRG Category for Inpatient Hospitalization with Median price spreadsheet is available HERE.

*Wisconsin region only – Some comparative price information is available through the Wisconsin Hospital Association.


Price Estimate Forms

Financial Assistance

Agnesian HealthCare is committed to offering financial assistance to people who have health care needs and are uninsured, underinsured or not eligible for a government program.