Hospital bills can be confusing. You possibly will receive one or more of three different types of hospital bills: summary bill, itemized bill, billing statement
NOTE: In addition to your hospital bill, you may receive separate bills from your physician(s): emergency physicians (care provided in the Emergency Department), radiologists (X-ray and other imaging services), consulting physicians (other physicians brought in by your doctor), pathologists (laboratory and microscopic examination test(s)), anesthesiologists (surgical procedures) and surgeons.
Commercial insurers usually do not pay hospital charges, but negotiate discounts with hospitals on behalf of the patients they represent. These negotiated discounts vary among commercial insurers. Numerous factors, such as type of plan, co-pay, co-insurance, deductible, out-of-pocket maximums and any limitations on coverage – such as whether or not the hospital is a participating provider in the insurance plan’s network – also will affect your financial responsibility. That is why it is crucial that you begin by talking to your insurance company to understand all of the factors affecting your financial responsibility.
The Explanation of Benefits (EOB), or a statement from your health insurance company, identifies the amount you owe for your hospital visit or outpatient procedure and what benefits were paid by your insurance company on your behalf.
Out-of-Pocket Costs, or “patient responsibility” is the amount you owe for the hospital visit or outpatient procedure. If you are insured, patient responsibilities are outlined in your health insurance policy and typically include a deductible, coinsurance and/or copayment. Many hospitals request that the patient responsibility be paid upon discharge. If you are unable to pay at that time, you should inform the hospital's patient billing office to make payment arrangements. Note that the unpaid balance might be subject to interest payments.
If you have two insurance policies providing hospital coverage, the primary plan must pay or provide its benefits as if the secondary plan(s) did not exist. A plan may consider the benefits paid or provided by another plan only when it is secondary to that other plan.
For patients without insurance, hospitals typically offer price discounts based on the patient’s income level and family size. You should contact the hospital’s business office for information on the facility’s policies and process to request a price discount.