5 ‘Real Money’ Tips Before You Get That Hospital Procedure

By ABC News

May 27, 2014 4:36pm

ABC News’ Paula Faris reports:

Sandy Marion of Keyport, N.J., is about to become a first-time mom but says she has no idea just how much the delivery of her new daughter will cost her.

Related: Tips on how to save on emergency bills.

“That fine print kills you every time,” Marion told ABC News.

So ABC News’ “Real Money” team introduced Marion to health care consumer advocate Michelle Katz to help her sift through her bills and help pick a hospital for her delivery.

Related: More tips on ways to save on your family’s hospital costs.

Getty Patient Surgery TG 140527 16x9 608 5 Real Money Tips Before You Get That Hospital Procedure

Getty Images

Katz shared the following tips:

1. Hospitals can charge vastly different prices for the same procedure. In Marion’s area, Katz found a difference of $14,000. She advised finding the range on your insurer’s website and shopping around.

“It depends on the hospital, what is outsourced and what is not, how long it takes, where the labs are outsourced,” Katz said.

2. Call your insurer and use this phrase: “Verifying coverage.” And then ask these three key questions: “Is there a limit to the visits? After the deductible is met, is that covered 100 percent? Is the anesthesiologist covered?”

Some insurers have caps, depending on the procedure. Katz found that Marion could be charged an extra $1,500 a day for some complications.

3. Some doctors at the hospital may not be covered by your plan so you could end up paying out of pocket for them. Katz said, when possible and a non-emergency, make sure a doctor under your plan sees you first.

“When the nurse comes around, say: ‘Can you please make sure the doctor puts into my chart that anything needs to be approved by me because of coverage?’” Katz said.

4. When possible, make sure the medications you are prescribed are covered as well. Katz said the doctor may not know what your coverage is.

In Marion’s case, she was paying $104 for a brand of prenatal vitamins that her insurance company only partially covered.

Katz suggested printing out what’s called a “formulary sheet” from your insurer’s website.

“Print out this list so when you go into the doctor, you present them with this list of formularies,” Katz said. “And this is all the drugs that are covered under your insurance plan. So this way the doctor’s not guessing.”

5. When the bill finally arrives, go through it line by line and question anything that’s not covered. Katz said that many claims got denied because of errors like an old address.

Katz found a $1,200 charge for lab work and an amniocentesis that should have been covered under Marion’s plan.

Katz said it was important to make sure your information was correct and up to date so that you didn’t get someone else’s bill or double billed.

“In the system, they give you a medical record number,” she said. “And if something is incorrect, they don’t know if it’s Sandy or a different Sandy.”

ABC News’ Eric Noll contributed to this story.

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