If you have ever read a medical bill from a procedure, test, surgery, or hospitalization, you might not recognize quite a few of the charges. It can be difficult, if not impossible, to piece together the care you received from looking at the statement. This fact can be quite frustrating, particularly when you have to pay a chunk of the bill out of pocket, for deductibles, co-pays and coinsurance. Confused by your hospital bill? You’re not alone.
A federal law requires hospitals to post what they charge online, but the numbers they post seldom have any relevance to the amounts that an individual will have to pay. The healthcare facilities seem to view their posted rates as a “list price” or the starting point for negotiations.
Although the legislation was supposed to address the problem of consumer confusion about how much hospitals charge for their services, in application, the inaccurate posted prices probably increase the confusion. Imagine the frustration if you went online to find out how much a hospital will charge for the procedure you need, only to get the bill and find that none of the numbers matches up. Some experts say that patients actually pay more than the posted cost.
Everything Is Open for Negotiation
Because they have the clout to do so, insurance companies start with the posted or list price and negotiate lower numbers with the hospitals. Many hospitals use a sliding scale or other financial aid programs, so the lower income patients can pay discounted rates for their services. Patients who do not have health insurance, can usually negotiate lower prices with the hospital.
Of course, the government does not care what prices the hospitals post for their services. Medicare disregards the posted prices entirely and tells the hospitals how much Medicare will pay them for their services.
Hospital executives often assume that patients only care about the out-of-pocket portion of the hospital bill. The danger of this mentality is that some insurance coverage has a lifetime benefits cap. If you receive a diagnosis of a significant medical condition or you experience a catastrophic injury, you might need every available dollar within that lifetime maximum for your current and future medical expenses. If a hospital padded previous bills, such as charging you for units of blood that you did not receive, many of those precious dollars may have gone to waste.
How to Address the Confusion
We wish we had a solution for how you can make sense of your hospital bill. However, at present, there is no such answer. Some people in the healthcare industry recommend that the patient call the hospital before a procedure or inpatient stay and speak with a financial counselor to get an estimate of their out-of-pocket costs.
Realize, however, that services for surgeons, anesthesiologists, radiologists, and other physicians usually are not part of the hospital’s estimate. To prevent wasteful charges reducing your lifetime insurance funds, request a paper bill from the hospital or your insurance company after the procedure and dispute incorrect charges.
Every state has different laws, so talk with an elder law attorney near you about how your state’s laws vary from the general law of this article.
AARP. “Hospital Price Postings Confuse Consumers.” (accessed March 7, 2019) https://www.aarp.org/health/health-insurance/info-2019/hospitals-post-prices-online.html