Patient Guide 
Key Information for Your Stay
Understanding Your Bill

Understanding Your Bill

What You Need to Know

The hospital billing process may seem complicated, but you can feel more in control by knowing exactly what your bill covers. For example, if you stay overnight, you can expect to see charges for your room, meals, 24-hour nursing care and medicines. The bill will also show charges for any special services, such as X-rays and lab tests. You’ll receive bills for doctors, surgeons, and specialists separately from the hospital.

Medicare

If you have Medicare, you may have to fill out an MSP (Medicare Secondary Payer) form. This ensures that Medicare only pays for services not covered by other insurance you may have. If you have secondary insurance, this usually covers Medicare deductibles. If you don’t have secondary insurance, you need to pay these amounts yourself.


Also be sure to read your quarterly MSNs (Medicare Summary Notices) to review:

  • the amount your doctor(s) charged
  • the amount Medicare approved and paid
  • the amount you owe
  • your current deductible status


If you have questions, call the customer service number listed on your statement.

Commercial Insurance Providers

If you use a commercial insurance provider, then the hospital forwards your claim based on the information you provide at registration. About a month after you leave the hospital, you’ll get an explanation of benefits (EOB) statement from your insurance provider. This isn’t a bill. 


EOBs show:

  • The amount billed by your doctor or hospital
  • How much of that cost is covered by your insurance
  • How much you owe


Review this and all other bill-related documents carefully. If you have questions, contact your doctor or the customer service number listed on the statement.

Self-Pay Patients and Payment Arrangements

If you’re planning to pay your bills without help from Medicare or a commercial insurance provider, then you’ll get bills directly from the hospital. Self-pay patients have the right to receive a “good faith” estimate before a planned hospital stay. To learn more, visit cms.gov/nosurprises.


When the first bill arrives, call the hospital’s financial services department to set up a payment plan. Communicate with the financial services department as soon as possible. If you don’t set up a payment plan, or if you stop making payments, then your account may be placed with a collection agency. The hospital wants to work with you, so reach out with any questions or concerns you have.

Avoid Surprise Medical Bills

Have you ever received an unexpected medical bill after seeing a healthcare professional or receiving a medical service in a hospital or outpatient facility? This may be a “surprise bill.” Under federal and New York law, you are protected against surprise bills.


When you receive non-emergency medical care:

  • It’s possible that doctors involved in your care may not participate in your health insurance plan—even if the hospital or outpatient facility does.
  • You have the right to know if the doctor providing these services participates in your health insurance plan, and if not, you can request a good faith estimate for the expected cost of non-emergency services.
  • Services provided by a hospital or other facility are billed separately than services provided by a doctor.


When you receive emergency medical care:

You’re only responsible to pay your usual health insurance plan in-network costs and copayment amounts, even if the emergency care was provided by a doctor who does not participate in your health insurance plan.


Resources:


And don’t forget to ask your doctor or a healthcare professional for all the information you are entitled to receive.

What to ask your doctor before you schedule nonemergency medical care:

  • Does the doctor participate in my health insurance plan?
  • Does the hospital or facility participate in my health insurance plan?
  • Can you provide me with a good faith estimate?
  • Make sure your provider(s) gives you a good faith estimate in writing at least one business day before you receive a medical service or item. You can ask your healthcare provider, and any other provider you choose, for a good faith estimate before an item or service is scheduled.
  • Make sure to save a copy or picture of your good faith estimate.
  • If you receive a bill that is $400 or more than your good faith estimate, you can dispute the bill.
  • Will there be other doctors involved in my care?
  • If so, ask for the name and contact information for each of the other doctors involved in your care.
  • You’ll need to contact each to find out if they participate in your health insurance plan.
  • If the doctor does not participate, ask for a good faith estimate for the services that will be billed.

Commonly Confused Terms

  • Deductible: The amount you owe each year before your insurance begins making payments. 
  • Co-payment: A flat fee you pay for a specific service, usually due at the time of service. 
  • Coinsurance: The portion of your medical expenses that you’re personally responsible for paying.

Keeping Track

One of the key ways to feel well-informed and less overwhelmed about the hospital billing process is to stay organized. Keep all of your statements and bills together, and review each one as it arrives.

Understanding Coordination of Benefits (COB)

COBs happen when you’re covered under two or more insurance companies. This may occur when spouses or partners are listed on each other’s insurance policies, or when both parents carry their children on their individual policies.


To prevent duplicate payments, COBs determine the primary payer. Your insurance providers follow guidelines to choose who pays first. Check with your insurance provider about their rules for COBs, primary payers and forms to fill out.

Need Help?

If you don’t understand something on your bill, or if you’re having trouble paying your bills, let us know. A patient representative can work with you.

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