How to deal with (and avoid) an unexpected hospital bill

Everyone is trying to cut down on health care spending—consumers, employers who offer health benefits, insurers, and the federal government.

As a result, new kinds of health insurance plans are being developed. Some have low monthly premiums but high deductibles and co-pays. Some plans offer lower premiums or co-pays, but limit your choice of doctors and hospitals. Some include health savings accounts (you deposit pre-tax dollars from your paycheck into the account and use them to pay for health care).

With some of these plans, if you have a sudden, serious health problem, or if you don't understand the details of your plan, you can end up with an unexpected hospital bill—even though you have health insurance.

You can't pay your hospital bill—now what?

First, know that you can turn to your hospital for help. As with any bill you are having trouble paying, it's best to call and work out a payment arrangement. If you met with a social worker or financial counselor when you went to the hospital or emergency room, connect with them. Many hospital websites list who to call about billing questions. Hospitals provide free "charity care" to people with low incomes. Depending on your financial situation, the hospital may be able to lower your bill or connect you with other types of financial assistance.

Avoid unexpected bills to begin with

The best way to avoid health care sticker shock is to do your homework. That starts with selecting your health plan carefully and making sure you understand it.

Whether you are choosing from plans offered by your employer, buying insurance on the Health Insurance Marketplace, or buying a Medicare plan, you must understand exactly how the plan works. Do you have to pay a certain amount out of your own pocket before your coverage kicks in? Will you have to pay for a percentage of your hospital stay? What are you billed if you use an "out-of-network" doctor or hospital?

Find out about your bill before you get care

For non-emergency tests, surgeries, and other health care services, get an estimate of the price of your health care upfront. Many health plans have estimators on their websites. You plug in your information and receive a price estimate, including the amount you will have to pay yourself. Or you can call your health plan. Learn more about how to estimate the price of your care in the Healthcare Financial Management Association's "Understanding Healthcare Prices: A Consumer Guide."

If you choose to go to an out-of-network doctor or hospital, make sure you understand what you will be billed for their services. Because your insurer does not have a contract with this health care provider, your financial obligations will likely be different than what you would pay an in-network provider.

If you are uninsured, it's very important to talk with your hospital about the price of your health care. Your hospital may be able to connect you to affordable health coverage. If your income is low, remember that enrollment in Healthy PA, Pennsylvania's version of expanded Medicaid, starts on December 1 for coverage beginning January 1.

Don't be afraid to talk dollars and sense with your hospital

If you are reading this because you have a hospital bill you didn't expect, you know that we have to do a better job talking with consumers and patients about the financial aspects of their health care.

Hospitals, doctors, insurers, businesses and employers—and you too—must work together to talk openly about health care prices. In Pennsylvania, hospitals have begun working together to identify and share the best ways to give patients financial information about their health care.

You can do your part by making it a point to understand what your health care costs you. Smart consumers can be a powerful force for improving the quality of U.S. health care while reducing what we spend for that care.1

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