Very few of us are glad to find a hospital bill in our mailbox. If the amount is small or at least manageable, we won’t worry too much. We should, of course, make sure that amounts are correct and then pay within the specified period, typically 30 or 60 days.
Many of you reading this article may be facing an unexpectedly or unaffordably high bill, e.g., after a visit to ER. Or you may be planning for a forthcoming medical procedure, e.g., a hip replacement, and wondering how much time you have until you have to pay your share of the bill. The planning stage is the best time to negotiate. Establish an estimated price, and get an assurance 9in writing) that all your service providers are within your plan network (see below).
The two scenarios have much in common: there are or will be bills to pay. Even the most comprehensive health insurance plan will leave you with something to pay, your deductible, copays, co-insurances.
The hospital’s responsibility is to bill your insurer with an itemized bill for the hospital treatment provided. Even if the hospital is ‘in the network,’ it is possible that some of the services you receive will come from providers not employed directly by the hospital. If you’re having elective treatment, i.e., planned treatment, you may have the opportunity to influence the choice of providers involved in your treatment. These choices may not be possible in the event of an ER visit.
- Your physician
- Emergency transportation
(For a fuller explanation, see our article When is a surprise not a surprise? When it’s a SHOCK!)
The outcome is that insurers will pay costs covered by your plan (in-network). Depending on the plan, they may pay a share of your out-of-network costs up to the equivalent in-network charges. You will be responsible for the balance. Some plans do not cover out-of-network charges at all. Ensure you are familiar with the Explanation of Benefits (EOB) which forms part of your insurance contract.
Now, to answer the original question. How quickly must I pay for my hospital treatment? In some cases, we might interpret this as ‘ how long have I got to find the money?
The hospital will invoice your insurer as soon as practical when your treatment is over. Most insurance providers commit to their network partners to meet their invoices within 60 days. During this time, they aim to complete their administrative checks and resolve any issues they may have with providers and possibly with you.
For a complex procedure, you should have a dated itemized bill.
It would be best if you crosschecked with the estimate you received before the operation (if you obtained one) or at least check that all the charges are valid. Are the dates and names of the providers, correct? Are any of the providers out-of-network?
You could reasonably expect not to be pressured into paying the ‘balance’ of your hospital bill within 60 days of being invoiced. The balance should be any deductible, copays, and co-insurances where applicable, + any balance billing for services billed by any out-of-network providers.
Finally, you may ask, how long can I delay payment? You could, of course, postpone payment indefinitely, but you run the risk of possible legal action and or inevitable loss of credit status.
See our article “I can’t afford my medical bills-What should I do?”
It is far better to negotiate with your providers who may accept a payment plan or even offer a discount for a cash payment. Be sure to have an agreement in writing.