Steps for Reviewing Medical Fees and Bills

The first step is to find out what your insurance covers and whether there is anything special you need to do to qualify for coverage, such as getting preauthorization from the health plan or getting a second opinion. For care provided by a specialist, many plans also require a referral from a primary care doctor for the highest level of benefits. Most of all, find out what copayments or what percentage of the bill you will have to pay.

The next step is to find out what the total bill—for you and your health plan—is likely to be. Medical fees can vary greatly from doctor to doctor and hospital to hospital. If you have a choice of hospitals, call each one to find out what a stay for your type of surgery usually costs or at least what the daily room rate is.

Feel free to also discuss financial questions with your surgeon or the office staff. Find out if the doctor’s office will fill out and submit insurance forms or if that’s your responsibility. Also ask if the doctor accepts the insurance payment as the full fee (called “accepting assignment”) or if you must make up the difference between the doctor’s fee and insurance payment.

Reviewing Your Hospital Bill

After your surgery or hospital stay is over, review your hospital bills carefully. Hospitals try hard to provide accurate bills, but errors do occur.

Ask the hospital billing office to explain unclear charges, terms, or tests. You can also ask for a copy of your bedside log or other medical records to use when checking your bill. If you need further help, your doctor’s office might be able to help.

Just like reading the labels on the foods you buy or checking the sticker to see what options come with a car you may buy, checking your hospital bills requires some time and attention on your part to be sure you are getting value for your dollar. Look at the fine print, and ask for more information about the bill if you think things are not adding up the way you thought they would. The following questions should help you identify any special problems with a hospital bill:

• Ask for an itemized bill instead of the summary most hospitals send.
• Were you billed for a semiprivate or a private room? Which did you have?
• Does the room rate multiplied by the number of days you stayed come to the same total as on the bill? (Most hospitals do not charge for the day of discharge.)
• Did you have each of the tests and procedures listed? You may be charged for something you didn’t have simply because of a clerical error or because your doctor cancelled the orders but the billing records weren’t changed.
• Do any charges seem unusually high to you, such as $3 for a dose of acetaminophen (Tylenol)?

If you find an error, call the hospital’s billing department and ask that it be corrected. If necessary, ask to speak with the department supervisor. Keep a written record of all your conversations, including the names of people you speak with and what you spoke about. Once the hospital agrees to correct the mistake, ask for a revised bill and then send a copy to your health plan. If you run into problems, call your health plan for help.

Before paying your portion of the bill, make sure your questions have been answered, errors are corrected, and your health plan has already paid its portion of the bill.