Health insurance usually determines where you get care and how much you will pay for it.
If You Have Health Insurance
Even if you have health insurance, you might have to pay some of your medical costs yourself. It’s important to find out. Call your health plan, explain your situation, and ask these questions:
- Will your care be covered by insurance at the hospital your doctor recommends?
- How much of the hospital bill and doctor fees will you have to pay?
Health insurance companies often have different arrangements for hospital coverage. Some may:
- Specify the hospitals you can use for care
- Not cover care at hospitals that are out of their network
- Cover only a portion of care
- Vary your payment share depending on which hospital you use
If you’re not satisfied with the answers your health plan gives you and you don’t need immediate treatment, you might consider switching insurers. Be prepared to do some research, and make sure to find out when you can change plans. Typically, and especially if you get your health care coverage through your job, this is only possible once a year, during the open enrollment period (the time of year when you sign up for your health plan). Also, your pre-existing medical condition may make it difficult to get coverage through an individual policy.
If You Don’t Have Health Insurance
You may be able to get financial help (also known as charity care) from a hospital. To find out, search CalHospitalCompare.org for a hospital and locate the “Discount Price Policy” link on the Overview page. The link will take you to the California Office of Statewide Health Planning and Development (OSHPD), where you can download the discount price policy. For more information on California hospitals’ free and discount payment programs, visit the OSHPD website.
Some hospitals offer payment plans that allow you to pay your medical bill over time at a low interest rate. Call the hospital’s billing office to find out about this option.
Whether or Not You Have Health Insurance
It’s a good idea to call the hospital’s billing office to find out what the daily rates and standard charges are for your procedure, as well as for your follow-up care. Read the California Health Care Foundation’s Eight Great Tips for Pricing Hospital Services for how to do this.
The hospital’s billing representative may also be able to give you an idea of the charges that will be billed separately from the hospital’s costs, such as fees for the surgeon, radiologist, and anesthesiologist. When estimating the cost of your care, be sure to factor in the annual deductible and copayments for your health insurance.