Going to the hospital is a stressful, often confusing, and potentially expensive experience. Whether it’s a visit to the emergency room in the middle of the night or a planned surgical procedure, hospital visits can be overwhelming, drowning you and your loved ones in paperwork, jargon, and occasionally imperious healthcare providers who don’t have much patience for questions.
As a result, too often folks just go along with everything that happens, only to receive a surprisingly huge bill at the end of their stay—and a surprisingly small amount of coverage from their insurer. While it’s always a good idea to request an itemized “super bill” from your hospital (because the chances that there are lots of errors in there are pretty good), you don’t have to wait until after you receive the bill to start fighting for your money. You can—and should—start way before the bill arrives. Here’s what you can do before and during your hospital stay to keep things under control.
Review your coverage
First and foremost, if you have insurance, you need to understand it. Sometimes people assume “having insurance” means everything will be paid for, and that is simply not true. Some insurance plans will require you to get pre-approval for procedures, and failure to do so will result in denial of your claim even if your plan covers it. If your trip to the hospital involves a specialist, you might also need a formal referral from your primary care doctor. Again, failure to do so may result in denial of the claim—pushing the full cost onto you.
It’s vital to understand that the healthcare providers you’re dealing with are not insurance experts. Even if they are experienced and have dealt with plenty of insurance in their time, they do not know the specifics of your coverage. Even if your doctor assures you that something will be covered, don’t believe them—review your plan and contact your insurer to make sure you know what is required.
Avoid out-of-network services
While you’re reviewing your coverage, pay close attention to the provisions regarding out-of-network costs. Your insurer has an approved group of healthcare providers and facilities where it has negotiated rates and typically won’t cover any services from outside that network. Using an out-of-network provider can therefore result in a surprisingly huge bill.
While the No Surprises Act of 2022 goes a long way to reduce the occurrence of surprise out-of-network costs, there is a long list of exceptions to the law that might come to bite you in the ass if you’re not paying attention. The act requires healthcare providers to give advance notice if they’re using out-of-network services and to obtain your consent for using higher-cost out-of-network services. Make sure that in the hubbub of being admitted to a hospital you don’t simply say yes to everything, and read everything you’re asked to sign to ensure you’re not giving the hospital carte blanche to go outside your network unnecessarily.
Share a room
While the trend in hospital design is moving towards a more flexible approach to rooms that can be reconfigured as needed, there are still a lot of pricey private rooms in hospitals. When being admitted, pay attention to the room assignment and request a shared room. While sharing a hospital room can be a miserable experience depending on who your roommate turns out to be, it will almost always be the cheaper option.
Get an Estimate
As with any large expense, it is always a good idea to get an estimate of what your hospital visit will cost. This will only be an estimate, so the actual costs may vary depending on unexpected circumstances or other factors, but it will at least give you some idea of what you’re in for, and will give you an opportunity to question anything that looks unnecessary or confusing before you have a large bill to worry about.
It can be helpful to do some research ahead of time, in fact. Federal law requires hospitals to post the costs of services they have negotiated with insurers. Sometimes a simple web search will turn up the info, sometimes a third-party tool can offer some information on pricing. Find out everything you can ahead of time, and compare the prices you’ve looked up to the estimate—and be prepared to challenge anything that looks way off-base.
Don’t pre-pay
Increasingly, hospitals are pressuring people to pre-pay for surgeries or other services, or to at least make a deposit if they can’t pay the whole thing. This is almost always a terrible idea. Depending on your coverage, your bill may come in much lower than the estimate, and you will have a heck of a time trying to claw that money back from the hospital. You almost never have to pre-pay, so your go-to tactic should be to simply refuse and tell them that you’ll wait to get a statement from your insurer. Refusing to pre-pay won’t cost you any more, and might save you a significant amount of money.
Know your status
When you’re being admitted to the hospital, determine what your official status there will be. The two most common patient statuses are inpatient and observation. This is important because if you’re admitted under observation, this is technically an outpatient status even if you’re staying at the hospital. As a result, your insurer may not cover the hospital costs or cover them to a much more limited extent because you’re not receiving “inpatient” care. If you notice you’re being admitted under observation status, ask for an explanation—and ask why you can’t be admitted with an inpatient status.
Monitor everything
While you’re in the hospital, you should focus on recovery and improving your health. But you—or an advocate—should also pay attention to what’s happening around you, because costs can mount up if you’re not careful.
One example is common medications: Your doctor will rightfully insist that you not bring any medications, even things like aspirin or acetaminophen, because they need to know precisely what’s in your system at any given time. That means if you have a headache you’ll need to request something like Tylenol and get it from the nursing staff. But every single pill they deliver will have a cost attached to it, so be aware that everything you ask for or consent to will add to your bill.
This includes doctors and other healthcare providers who stop by your bedside. Every single provider who walks into your room and interacts with you could be considered to have engaged in a consultation, and every consultation will add money to your bill. So-called “drive-by consultations” aren’t common, but you should know every provider working with you and why they are necessary to your care.
Evaluate equipment
When you’re finally discharged from the hospital, your healthcare team may insist on giving you a bunch of stuff. Canes, slings, and other equipment might be handed to you, and you might be assured that your insurance will cover them all—but unless you have checked on this and know with certainty, you should evaluate each piece of equipment. You can often purchase these things much more cheaply at a local pharmacy or online retailer. If your insurer won’t cover something, you might wind up paying a lot more than necessary for something you’ll only need for a short time.