Understanding Your Bill

Take Charge of Your Payments

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 may receive bills for doctors, surgeons, and specialists separately from the hospital.

• Total charges: the total price of the services you received.
• Allowed amount: the amount that your health plan will pay for a service. In some situations, you may have to pay the difference between the allowed and total charges. This is called “balance billing.”
• Insurance payment: the amount your insurance has paid or will pay after you pay your portion.
• Patient payment: an amount you may have already paid, such as a copay.
• Patient responsibility/balance due: the amount remaining that you need to pay.
  

If you have Medicare, you will be required to complete 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 use a commercial insurance provider, the hospital sends a claim to them. Later, you'll receive 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 may 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.

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, contact the hospital’s business office to resolve your outstanding balance. If you need help paying your bill, visit avmc.org/helppayingyourbill. If you do not qualify for financial assistance, arrange for a payment plan. If you stop making payments, 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.

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.

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.

Need Help?

If you don’t understand something on your bill, or if you’re having trouble paying your bills, let us know. Contact the Financial Counseling department at 661-949-5635.