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5 myths about hospital billing

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Health insurance and billing can often be confusing for patients. Without knowing exactly what insurance will cover or how the medical billing system works, patients are often left frustrated by trying to understand their bill.

Here are five myths about hospital billing and how to be prepared for your bill.

cartoon of health insurance card, heart with heartbeat and doctor holding tablet

Myth #1: My health insurance covers everything and I’ve already met my deductible, so I shouldn’t have to pay anything

Even if you’ve met your deductible, there are often different levels or plans of health insurance available that can make medical billing confusing. Just because you have met your deductible, doesn’t mean you will not owe money when all is said and done.

Most insurances will continue to pay at 80 percent after a deductible is met, which means a patient will to pay 20 percent of allowed medical charges (co-insurance and co-pay) until you meet the maximum out of pocket.

Upon registration, all patients sign a form stating they are responsible for whatever amount insurance does not cover. A good practice is to always be prepared to pay something and call your insurance before your procedure to get an idea of what you might owe.

hand up to catch flying money

Myth #2: As long as I make payments to the hospital or doctor’s office, they won’t send my account to collections

This isn’t always true. It’s always best to have a payment plan arrangement set up through the hospital or doctor’s office from where you’re being billed.

At Newton Medical Center, you can also set up payments through The Midland Group, who partners with us and helps you break larger bills into easy, low-interest or no-interest payments.

The Midland Group is not a debt collector but will work with you to find reasonable monthly payments to fit your budget.

Cartoon hand exchanging money for invoice (medical bill).

Myth #3: Medical bills are always right

Contrary to popular belief, hospitals and medical facilities are not just out to take people’s money. The billing department is full of regular human beings who are not free from error. Sometimes, it’s a matter of insurance rejecting a claim or a code on that claim that just needs to be resubmitted.

When you get your medical bill, it’s a good practice to compare it to the Explanation of Benefits (EOB) that you receive from your insurance company, so that you understand how different items are paid.

It’s also good to keep in mind you may get several different statements depending on the procedure. Medical billing can be confusing because facility charges, anesthesia and doctor bills are sometimes all billed separately.

cartoon doctor sitting at computer with table and talk bubbles

Myth #4: If the hospital is in-network, so is the doctor

Most people know that finding in-network care benefits them and means lower costs. But that doesn’t mean all doctors that practice at the facility where you get your procedure done are also in-network. That’s because not every doctor that has privileges at the hospital is actually employed by the hospital. Lots of organizations work with outside physician groups. Most of them are probably in-network, but some might not be.

It’s difficult to avoid this entirely, and there still might be some out-of-network costs on your bill. If you know you’ll be undergoing a procedure, it’s a good idea to call your insurance company and hospital to make sure anyone who sees you is in-network. You also should be making sure the hospital or facility takes your insurance, as some insurances are not accepted.

cartoon guy with money in hand, handing money to hospital building

Myth #5: I have to use insurance to get lower costs for healthcare

Just because you have health insurance doesn’t mean you have to use it. It also doesn’t mean it’ll be the cheapest option.

NMC partners with MDsave, a company that helps offer discounts for common procedures for patients who want to pay out of pocket, and it will not be billed to your health insurance.

With MDsave, patients can save up to 60 percent on healthcare for medical procedures, common lab tests and imaging.

Contact Us

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If you have a question about your bill, call the Patient Financial Services department at (316) 804-6255 or 1 (800) 811-3183. Our staff will take care of you and help explain what may or may not be going on with your bill.

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