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Healthy Tips

5 Things to Know About Your Medical Bill

Clearing Up Hospital Bill Confusion

Medical bills can be complex and confusing, but a little bit of information can help you navigate your way. Here are five important things to understand about your hospital bill:

1. Your bill probably contains medical jargon.

It may seem like alphabet soup, but the codes that appear on your statements actually help your insurance company figure out what’s covered, and what’s not. The codes also help physicians, hospitals and healthcare providers talk the same language when it comes to patient care and sharing medical data.

2. Your insurance carrier determines coverage.

As soon as your hospital or healthcare provider generate a claim, your insurance company determines how much your plan will cover. It can be difficult to provide an estimate of costs because it depends on how much time your physician spends with you, the complexity of the visit and other factors.

3. The explanation of benefits (EOB) is not a bill.

Your insurance company will send you an EOB, which outlines the services that were billed by a healthcare provider and how those charges were processed. The EOB also tells you the amount that you are responsible for paying. But, before you pay anything, you should wait to receive a billing statement from your hospital.

“Patients often think the EOB is another billing statement. Typically, you receive the EOB first, and then it can take a few weeks before the hospital sends out a billing statement,” explains Omar Salim, manager, financial counseling, Northwestern Medicine.

4. Non-covered vs. out-of-network.

These terms may seem similar, but they are very different. “Non-covered” means the service is not covered, and you will have to pay for the entire cost in order to receive it. On the other hand, “out-of-network” indicates the physician or facility is not a preferred provider. The service may not be covered at all, or you may be responsible for paying a larger amount than if you chose an in-network provider.

5. Patient portion comes in the mail.

If you are uninsured or your insurance company does not pay for your treatment in full, you will receive a statement in the mail. Often, insurance plans do not cover the entire cost of your care, resulting in a “patient portion.” This may include a co-pay, services not covered by your deductible and “out-of-network” or “non-covered” costs.

“When in doubt, be sure to ask questions. Coverage is always determined by the insurance carrier, not the hospital, so it is important to contact your insurance company to ask questions about your benefits,” says Salim.

If you are unclear about the cost or coverage of a particular procedure, the hospital or healthcare provider offers a financial counseling office to help you make informed decisions. If you are unable to pay your bill, most hospitals offer financial assistance programs and interest-free payment plans.