A Trip to the Hospital: How to Know What You Pay for and What Insurance Will Cover

Saturday, May 10, 2014, 1:00 AM | Leave Comment

Hospital visits can put a strain on your budget whether you need a few stitches or spend days recovering in a room after surgery. Knowing what you are expected to pay for can help you prepare to save money and ensure that you don’t end up paying for things that should be covered by your insurance.

A Trip to the Hospital - How to Know What You Pay for and What Insurance Will Cover

Your obligations will vary based on the hospital, your insurance, and the reason for the hospital visit, but this is a general summary of your responsibilities and what your insurance might pay for so that you don’t end up paying too much.

  • Deductible

    Look at your deductible first when wondering about expenses. You have to pay the deductible amount before coverage starts, so this is the minimum amount you may be liable for after a hospital visit. Your insurance will usually cover the bulk of all fees after the deductible is met, and your deductible may be waived if you spend a day or more in the hospital.

  • Co-Insurance

    The co-insurance is the next thing to factor in, and it determines how you and your insurance provider split the bill after the deductible is paid. The insurance company will handle most of the bill, but you could be responsible for around 20% of the cost. There is a limit on how much co-insurance you are required to pay.

  • Specific Costs For Services

    If you know what your care at the hospital will entail, you can look up the cost for specific procedures in your plan. The cost of particular things like blood work, medicine and operating room time may be divided between you and your insurance company like co-insurance, or your plan may have limits for different services. If X-rays cost $250 and your plan stops X-ray coverage at $200, you would have to pay $50 if you need X-rays.

  • Small Coverage Zones

    Find out what type of procedures your insurance rarely pays for. Many plans do not pay for elective surgery, and new or experimental treatments may not be approved by insurance either. Doctors recommendations, group health plans and state rulings can influence what is covered.

  • Unforeseen Expenses

    You may think everything has been handled after your hospital bill has been paid, but there is probably someone you still owe. Many doctors and surgeons handle their own billing separately from the hospital. Your insurance could pay all or part of this cost, but keep the doctor’s fee in mind when estimating the cost of a hospital visit.

Take a close look at your plan so that you know what you are covered for in case of an injury or emergency. Sometimes people are in such a frenzy when they visit the hospital that they sign papers and agree to pay for things that they really shouldn’t have to.

Don’t end up with extra bills just because you are uninformed about the terms of your coverage. Educate yourself about your particular plan so that you can get what you deserve when the unfortunate occasion of visiting the hospital arises.


This article was written by Dixie Somers, a freelance writer who loves to write for business, finance, women’s interests, and the home niches. She lives in Arizona with her husband and three beautiful daughters. Dixie got her advice for this article from personal injury lawyers in Vancouver at Kenneth Cristall Legal who specialize in helping clients with insurance claims and other matters following an accident or injury.

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