When your family receives a hospital bill, you may be shocked when you see the amount due. Interpreting your hospital bill can help you protect yourself if you think the amount is wrong. Below are some of these important terms to know and what steps you can take to better understand your medical bill.
This made-up charged price has no bases at any kind of cost to the provider. If you are not insured, you will be charged this price which can be a large amount. These things are always negotiable. You can call the number and speak to supervisors and managers, or continue to call. The more you call, the lower the arbitrary price will be.
This is the negotiated price between the provider and the insurer. These are not made public and no one knows if they are accurate or appropriate. If you think that this number is incorrect, call your insurance company before you pay the bill.
This is the amount discounted by your insurer for the hospital or emergency room. This amount is the difference between your billed amount and your allowed amount. This represents your savings based on the contracted rate that a facility has negotiated with either your government healthcare insurer or your private healthcare insurer.
This is a round number, you either have an individual or a family deductible. This amount can be around $1,000-$3,500 for an individual and averages around $9,000 for a family, depending on your plan. The statement from the hospital will have the amount you have to pay to meet our deductible. Once your deductible is met, you are no longer responsible for paying it.
This is the amount you are responsible for paying because your service was not covered by your plan or the facility provider was outside the plan’s network. This is where people start to get manipulated due to non-covered charges. You are entitled to know before your service if it is covered or non-covered service.
An example of this is when you go to a grocery store, you are told how much the item is going to cost before you get to the checkout line. They cannot charge a price that is not shown. At the hospital, if they claim that services are not covered, you need to call the number at the bottom of the statement and ask the facility why this was not covered, and what billing code was used. There is a billing code they have to use for each service that they provide.
In addition, sometimes they will add a service, like a numbing agent used during your operation that should have been covered with the operation. Make sure you are paying for the services you received.
If you are not sure about a particular charge, keep calling and keep asking. Some charges may not seem like a big amount of money but they are worth fighting.
Family Out-Of-Pocket Max
Sometimes, even if you have met your deductible as a family, you may have to pay a certain percentage of that to reach the out-of-pocket maximum before the insurance coverage kicks in. This is the maximum for in-network expenses, only if the family was to receive treatment from an out of network place or facility.
However, you can still end up paying more than the deductible as a family and the out-of-pocket maximum in healthcare expenses. You need to pay attention to what your benefits are. Check with your insurance provider, whether it be your employer or private company, to know what you are getting and what your responsibilities are.
This can be very complicated due to the number of insurance plans available and the complexities of each.
This is an item that can show the negotiated discounts for each item on the bill. Most bills do not have claim details in them because it is a great way for hospitals to cover up prices. You don’t realize that certain things have itemized prices. For example, you get charged for a splint, charged for an x-ray, an evaluation of the x-ray, and for pain meds. Often these charges are not reasonable and are often inappropriate to be listed as individual charges.
There are some pretty heavy discounts you can get if you look at the claimed details, as these are often very arbitrary costs.
Make sure you look at the source for each of the services that are provided. You have the right to know what you are paying for. You need to ask questions and find out what the different charges mean.
Most places will be happy to give an itemized list but if you are getting stonewalled, ask to speak to a supervisor who can help you with interpreting your hospital bill. You will get an answer to why you are getting charged.