Understanding your hospital bill

A hospital bill will list the major charges from your visit. It lists the services you received (such as procedures and tests), as well as medicines and supplies. Most of time, you will get a separate bill for health care provider fees. It is a good idea to ask for a more detailed hospital bill with all of the charges described separately. That can help you make sure the bill is correct.

If you have health insurance, you may also get a form from your insurance company, called an Explanation of Benefits (EOB). This is not a bill. It explains:

• What is covered by your insurance
• Amount of payment made and to whom
• Deductibles or coinsurance

A deductible is the amount of money you must pay each year to cover your medical care expenses before your insurance policy starts to pay. Coinsurance is the amount you pay for medical care after you have met your health insurance deductible. It is often given as a percentage.

The information on the EOB should match your hospital bill. If it does not, or there is something you do not understand, call your insurance company.

Errors on your medical bill can cost you money. So it is worth the time to check your bill. Check the following items carefully:

• Dates and number of days. Check that the dates on the bill match when you were in the hospital. If you were admitted after midnight, make sure the charges start on that day. If you are discharged in the morning, check that you are not charged for the full daily room rate.
• Number errors. If a fee seems too high, check that there are no extra zeros added after a number (for example, 1,500 instead of 150).
• Double charges. Make sure you are not billed twice for the same service, medicine, or supplies.
• Medicine charges. If you brought your medicines from home, check that you were not charged for them. If a provider prescribed a generic medicine, make sure you are not billed for the brand-name version.
• Charges for routine supplies. Question charges for things such as gloves, gowns, or sheets. They should be part of the hospital's general costs.
• Costs of reading tests or scans. You should be charged only once, unless you got a second opinion.
• Cancelled work or medicines. Sometimes, a provider orders tests, procedures, or medicines that are later cancelled. Check that these items are not on your bill.

If you had surgery or another procedure, it helps to know whether your hospital charged a fair price. There are some websites you can use to help you find this information. They use national databases of billed medical services. You enter the name of the procedure and your zip code to find an average or estimated price in your area.

• Healthcare Bluebook - www.healthcarebluebook.com
• FAIR Health - www.fairhealth.org

If the charge on your bill is higher than the fair price or higher than what other hospitals charge, you can use the information to ask for a lower fee.

If you do not understand a charge on your bill, many hospitals have financial counselors to help you with your bill. They can help explain the bill in clear language. If you find a mistake, ask the billing department to correct the error. Keep a record of the date and time you called, the name of the person you spoke to, and what you were told.

If you find an error and do not feel you are getting the help you need, consider hiring a medical-billing advocate. Advocates charge an hourly fee or a percentage of the amount of money you save as a result of their review.

If you cannot pay your bill in full before the due date, you may have options. Ask the hospital billing department if you can:

• Get a discount if you pay the full amount in cash
• Work out a payment plan
• Get financial aid from the hospital

American Academy of Family Physicians website. Understanding your medical bills. familydoctor.org/understanding-your-medical-bills. Updated July 9, 2020. Accessed July 31, 2024.

American Hospital Association website. Avoiding surprises in your medical bills: A guide for consumers. www.aha.org/guidesreports/2018-11-01-avoiding-surprises-your-medical-bills. Updated 2018. Accessed July 31, 2024.

Centers for Medicare & Medicaid Services Website. Fact sheet. No surprises: understand your rights against surprise medical bills. www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills. Published January 3, 2022. Accessed July 22, 2024.

FAIR Health Consumer website. Understanding your bill: how to review your medical bill. www.fairhealthconsumer.org/insurance-basics/your-bill/how-to-review-your-medical-bill. Accessed July 31, 2024.

Pollitz K. No Surprises Act implementation: what to expect in 2022. Kaiser Family Foundation website. www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022. Published December 10, 2021. Accessed July 31, 2024.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.