Protect yourself from outrageous hospital bills
You’re in the hospital to protect your health. But you also need to protect your financial health while there — by asking the right questions. Since more of us now have insurance plans that feature high deductibles and significant copayments, the cash is more likely than ever to be coming out of your wallet. While high-deductible plans are featured on the Affordable Care Act’s marketplaces, many employers have also moved in that direction, with 28% of firms offering such plans in 2016 compared to only 7% in 2007, according to the Kaiser Family Foundation.
Unless you are on Medicare or are a member of an HMO, your stay is (for now) most likely being billed intervention by intervention, visit by visit, item by item. Here are five ways you can protect yourself:
Avoid a private room. Hospitals have built a huge oversupply of private rooms, though insurers frequently won’t cover their cost. If you are assigned to a private room, make it clear you didn’t request it and would be happy to occupy a room with another patient. Otherwise, you might be hit up to pay the “private room supplement” by your insurer.
Avoid out-of-network charges. In the pages of admitting documents you’ll have to sign, there is inevitably one concerning your willingness to accept financial responsibility for charges not covered by your insurer. Before you sign, write in “as long as the providers are in my insurance network.” You don’t mind paying the required copayments or deductibles but not out-of-network charges. For every medical encounter, Olga Baker, a San Diego lawyer, adds a “limited consent” clause to the chart, indicating that “consent is limited to in-network care only and excludes out-of-network care.” It has worked well for her and, at the very least, this annotation will give you a basis for arguing later.
Be clear on the terms of your stay in the hospital. Are you being admitted or held on “observation status”? Ask point-blank. The answer will have big implications for your wallet. Hospitals can keep you for up to three days (two midnights) on observation status. Though you will be in a hospital bed, you will be considered an outpatient and be responsible for outpatient copayments and deductibles, which are generally far higher than those for an inpatient stay. If you are on Medicare, the government insurer won’t count days on observation status toward its required three days of hospitalization required for coverage of a stay in a rehabilitation center or nursing home after discharge.
Ask why you cannot be fully admitted. If there’s not a good answer, insist on going the inpatient route.
Know the identity of every unfamiliar person who appears at your bedside. If you’re feeling well enough, ask what he or she is doing, and who sent him or her. If you’re too ill, ask a companion to serve as gatekeeper and guard. Write it all down. Beware the nice doctor who stands at the foot of your bed each day and asks if everything’s going OK. That pleasantry may constitute a $700 consultation.
There’s an epidemic of drive-by doctoring on helpless inpatients. These medical personnel turn up whether you need or want them, with the intent of charging for their services. Remember that you can say no. Everything done to you or for you in the hospital will be billed at exorbitant rates.
Refuse unnecessary equipment. If the hospital tries to send you home with equipment you don’t need, refuse it, even if it’s “covered by your insurance.” This is a particular concern if you’ve had an orthopedic procedure. Avoid $300 bills for slings you could buy for $10 at a pharmacy, $1,000 knee braces, and $2,500 wheelchairs, all billed to insurance and cluttering up your front closet.
By asking these 5 questions you can empower yourself and avoid unnecessary spending. But if you remember only one thing, make it this: You can always say “no.”