A hospital stay or ER visit is stressful enough, and then comes the bill.
“When something happens, the first question people ask is, ‘Am I going to be OK?’ The second is, ‘How am I going to pay for this?’” says Sarah Lucas, associate vice president for Enterprise Revenue Cycle at UW Medicine. “Our goal in Revenue Cycle is to partner with patients to make this process as clear and seamless as possible so they can focus on their health and healing.”
Whether it’s a routine checkup or an ER visit, understanding your bill, rights, insurance coverage and payment options can make receiving and paying for care more manageable.
What’s included in a hospital bill?
A hospital bill includes the summary of the care you received (medications, procedures, tests, physicians, etc.) and the charges for those services.
If you have insurance, you will also receive an EOB or an explanation of benefits, which lists what the hospital charged, how much your insurance paid and what you still owe.
The charges listed on your EOB vary based on your insurance coverage. This may include your deductible, which is the amount of money you must pay out of pocket before your insurance plan kicks in; your coinsurance, which is the percentage of money you must pay out of pocket for covered services after you’ve met your deductible; and your copayment, which is a fixed fee for various visits.
Say, for example, you’ve met your deductible and have insurance that covers 90% of the bill. Your coinsurance is the other 10% of the bill that you are financially responsible for — meaning you still share some of the cost.
What are facility fees and physician fees?
In some cases, after a hospital visit, you’ll receive additional bills for facility fees and/or physician fees.
A facility fee is a charge for visiting a hospital-owned location, even if you are not seen in the hospital itself. The fee covers the supplies, resources, nursing care and staff.
In Washington, all healthcare locations with a facility fee are required to post this at the clinic and tell you in advance so that you aren’t surprised by a facility fee.
A professional fee is a charge you receive from providers who see you during your visit. Basically, some doctors bill separately from the hospital, so they will send a separate bill for the service they provided while you were in the hospital.
It can be confusing (and frustrating) to receive multiple bills for one visit, but luckily some healthcare systems like UW Medicine have moved to a single business model where you receive one bill with all charges and fees included.
“Since March of last year, you get a patient statement from UW Medicine with hospital charges and physician charges, as well as a summary of any insurance payments and adjustments. If a person is uninsured, the document will also include any discounts applied,” says Larry Blythe, the director of Patient Accounts and Support Services at UW Medicine.
How much does it cost to go to the hospital?
How much you owe depends on what care you receive and your insurance coverage, but this doesn’t mean the bill needs to be a mystery.
In Washington state, healthcare providers and facilities are required to provide an estimate of costs upon request for hospital services, visits and stays, as well as any additional charges such as facility or provider fees.
Due to the No Surprise Act, hospitals and providers are required to provide an estimate for self-pay patients within three business days of their scheduled service. This estimate helps you determine roughly what it will cost for your visit. Plus, if you are uninsured and charged $400 or more than the good faith estimate amount, you can dispute the bill within 120 days.
At UW Medicine, you can also use an online tool to determine how much you will have to pay for 300-plus of the most common medical services based on what location you go to, your insurance coverage and any uninsured or self-pay discounts that would be applied.
If you’re insured, both Lucas and Blythe recommend talking to your insurance company as well, as they are the ones ultimately determining how much you will pay based on your benefits. And you can always contact the hospital’s financial services team to get help.
“We are here to help patients navigate the finances of their care. By the time you get the bill, if you’ve reached out and allowed us to help, there shouldn’t be any surprises,” Lucas says.
What charity care and financial assistance options are available to help cover a hospital bill?
Hospitals in Washington are required to provide care regardless of your ability to pay and must provide charity care, or financial assistance for families below federal poverty guidelines. You can find each hospital’s charity care policy on the Washington Department of Health’s website.
“At UW Medicine, we go to great lengths to provide resources so that patients don’t have to do this alone,” Lucas says. “We take patient care seriously in terms of their financial experiences. We are committed to easing their journey so they can focus on healing.”
At UW Medicine, there are self-pay discounts for uninsured individuals and those deciding to pay out of pocket; financial assistance may also be an option; flexible, interest-free payment plans can be tailored to your individual circumstance, including prepay and uninsured discounts; and additional case-by-case support may be available for extremely high bills that exceed what most individuals would be able to cover.
“We screen for financial assistance and communicate financial assistance on every statement, price estimate and bad debt statements,” Lucas says. “The point is the financial assistance conversation stays open for the entire time you have a balance with us.”
Get help understanding and paying for your hospital bill
Healthcare can be complicated, but if your bill reads like a riddle, the upside is there are people available to help.
Who to call:
- If you have questions about your health benefits, call your company’s human resources to discuss available insurance plans.
- If you are insured and have questions about your bill, call your insurance company.
- If you are uninsured and have questions about your bill, call the hospital’s financial services.
- If you need help paying your bill, call the hospital’s financial services.
The bottom line? You aren’t alone in navigating your bill.
“If you need help, whether or not you have insurance, we have an army of amazing professional staff available to answer questions and provide care as much as possible,” Blythe says.
“Please contact early and often, we are here to help,” Lucas says.