Understand how much you will be expected to pay before receiving hospital care
If you have health insurance, contact your insurer and:
- Explain what is to be done, when it will be done, and by whom (hospital/physician).
- Confirm that the procedure and the provider will be covered.
- Ask if there are any limitations to the coverage.
- Ask what the expected out-of-pocket costs will be.
- Ask if the out-of-pocket costs would be less if a different hospital/physician was involved.
The Washington Hospital PricePoint Web site provides information on billed charges for all types of inpatient care and selected outpatient services. However, lower hospital charges may not necessarily mean you will pay less out of your pocket. That is why it is important for you to contact your insurer.
Many commercial insurance companies and employer self-funded plans require enrollees to seek care exclusively from a specific group of hospitals and physicians in order for the service to be covered. This group of hospitals and physicians is often called a “network.”
Other insurers and employers will cover the services of hospitals and physicians that are not in the network, but will require patients to pay a higher percentage of the cost if they use the services of non-network providers.
If you are required to use the services of physicians who are in your insurer’s network to receive the highest level of coverage, ask your insurer for the names of the anesthesiologists, pathologists and radiologists in the network who provide services at the hospital. These are the types of physicians who may provide services related to your inpatient stay or other hospital service, but it’s possible you may never personally interact with them. As with surgeons, they are often not employees of the hospital, so their services will probably be billed separately. If they are not part of your insurer’s network, you may be responsible for a larger portion of their fees or all the fees.
If you do not have health insurance:
Contact the hospital and ask about its payment policies. Hospitals have charity care policies that offer partial or total fee reductions, or payment plans, to patients who have a financial need. However, hospitals expect patients to cooperate in the eligibility determination process.