Understand Your Medical Bills

Friday, September 9, 2011, 2:00 AM | Leave Comment

A couple of months ago, I went to the hospital with a family friend who was sick. He was admitted and was inpatient for two days. When he got back home, medical bills followed him after a couple of weeks. At first, he thought it would be just one bill and he and his insurance company would take care of it. But the bills were coming one after the other.

I did some research, talked to the hospital administration. I got some information from the hospital, physicians and other medical personnel. I like to share it with you.

The reason for getting more than one bill is simple once you understand how hospitals are staffed and structured.

  • Nearly all hospital-based physicians are independent contractors. The hospital is their workplace, but they are not hospital employees.
  • Nearly all physicians are in private practice and therefore do their own billing.

So how are medical expenses broken down? Let’s say you go in for a routine scheduled surgery. Upon discharge you will receive a bill from the hospital for all aspects of your care that did not involve a physician’s time.

So, basically, there are two kinds of bills – Hospital bill and Physician bill.

Hospital bill
The hospital bill will likely include

  • medications,
  • room and board,
  • nursing care,
  • housekeeping,
  • meals, and
  • lab work.
  • And maybe, some ancillary – or auxiliary – services from

  • physical,
  • occupational,
  • speech, and
  • respiratory therapists.
  • If you had imaging studies taken during your stay, such as

  • X-ray,
  • CT scan,
  • MRI or
  • ultrasound,
  • the hospital bill will also include a charge for the radiology technician and imaging equipment – although it will not include the consultation fee from the radiologist who reviewed your test results.

Physician bill
In addition to the hospital bill, you will receive separate invoices from any physicians who were involved in your care. These may include

  • anesthesiologist,
  • the surgeon,
  • the radiologist,
  • your primary care physician, and
  • any other sub-specialists who may have been involved in your treatment.
  • In some cases, you may receive a bill from a physician whom you did not see in person, such as a pathologist called in for a biopsy reading
  • If you were admitted to the hospital through ER, you can also expect to receive an invoice from the attending physician you first saw in the emergency room.

While the hospital will work closely with your insurance company, it’s important to be familiar with the details of your benefits plan. Every plan is different.

Since hospitals are not a part of the insurance network, they don’t have information about what is covered or how much a patient will have to pay out of pocket.

Patients who are well-informed and know their insurance policies are often their best advocates and are less likely to pay more than they have to.

Review your benefits
If you are scheduled for an upcoming procedure of any kind at the hospital, be sure to contact your health insurance company ahead of time for an overview of your inpatient benefits.

Ask these helpful questions:

  • Is the particular procedure covered by your health plan?
  • Is it covered in full? If not, what percentage is covered?
  • Does your health plan cover related services such as diagnostic testing, lab work, or follow-up treatments and/or therapies?
  • Is there a deductible and/or copay?
  • Do you need pre-approval for the procedure?

An informed patient is an empowered patient
Get information as much as you can. You obviously have access to the Internet, do research. Get online at your insurance website.

Moral of the story
May God bless America and the American people.

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