It’s dif­fi­cult to pre­dict when and even how a per­son might end up in the hos­pi­tal. How­ev­er, you can take steps to plan so that your health insur­ance pol­i­cy takes care of the bills, and your focus can be on recovery.

Health insur­ance is most fre­quent­ly used for fill­ing pre­scrip­tions and annu­al check­ups, but the most impor­tant func­tion of a major med­ical insur­ance pol­i­cy is cov­er­ing the large expens­es incurred with seri­ous ill­ness or injury result­ing in a hos­pi­tal stay.

First—unexpected caus­es of hos­pi­tal­iza­tion include:

  • An acci­dent or ill­ness result­ing in an ER vis­it that leads to a hos­pi­tal admission
  • Sched­uled (or last-minute) pro­ce­dures as part of treatment
  • Unsched­uled hos­pi­tal admis­sions because of a diagnosis

Next—how to make your hos­pi­tal stay eas­i­er to manage:

1) Set Up Access to Your Health Insurance Portal

This is impor­tant to access your mem­ber infor­ma­tion, includ­ing the pol­i­cy num­ber and med­ical claims sub­mit­ted to your pol­i­cy. A hos­pi­tal vis­it gen­er­ates a tremen­dous num­ber of invoic­es and claims. Online access makes it eas­i­er to see claims with­out con­tact­ing the insur­ance com­pa­ny, sav­ing valu­able time.

The por­tal will have a down­load­able Expla­na­tion of Ben­e­fits (EOB) so you can track your annu­al deductible and max­i­mum out-of-pock­et amounts. You’ll also be able to see if all claims are being sent cor­rect­ly to the insur­ance company.

A provider sub­mit­ting claims to the incor­rect pol­i­cy or insur­ance car­ri­er is a com­mon error. Your provider may send you a bill stat­ing that the med­ical pol­i­cy is invalid. In this sit­u­a­tion, your por­tal will not show such a claim. Until the EOB is avail­able on the por­tal, you shouldn’t pay any invoice to the provider since the claim has not been prop­er­ly processed.

2) Your Hospital May Belong to A Different Health System

Doc­tors and spe­cial­ists may not be part of the hos­pi­tal staff where you’re under­go­ing inpa­tient treat­ment. That means hos­pi­tal claims will be sep­a­rate from the fees asso­ci­at­ed with doc­tors and specialists.

Exam­in­ing the EOBs on the por­tal will make it eas­i­er to deter­mine how the insur­ance pol­i­cy paid for each type of claim.

3) Prepay The Annual Deductible

Some hos­pi­tals may require you to pre­pay your deductible. Check your pol­i­cy to see how much deductible remains. If you have pri­or med­ical claims, you should pre­pay only the remain­ing amount.

4) Give a family member or trusted person access to your health insurance information.

It is help­ful to have your insur­ance infor­ma­tion acces­si­ble to fam­i­ly mem­bers while (and even before) you find your­self hos­pi­tal­ized. They can help com­mu­ni­cate with your health­care team, assist with med­ical bills and pro­vide sup­port so you can focus on get­ting well.

5) Not All Hospital Stays Are Inpatient

Inpa­tient med­ical care usu­al­ly means the patient is admit­ted and stays overnight. Some insur­ance car­ri­ers define an overnight stay as requir­ing 15 or more hours.

How­ev­er, not all overnight stays are con­sid­ered inpa­tient stays.

If you vis­it the ER or hos­pi­tal with an ill­ness or injury, the attend­ing physi­cian may keep you there for obser­va­tion, includ­ing through the night. You could be placed in a room or anoth­er part of the hos­pi­tal facil­i­ty, but you aren’t con­sid­ered admitted.

In case of an out­pa­tient pro­ce­dure per­formed at the hos­pi­tal with an overnight recov­ery, you will be placed in a patient room and treat­ed like any oth­er admit­ted patient. But for billing pur­pos­es, it may not be con­sid­ered an inpa­tient stay.

Why is this distinction important?

This detail may be impor­tant if a bill is cov­ered with hos­pi­tal expense sup­ple­ment plans, also called gap or hos­pi­tal indem­ni­ty plans.

For exam­ple, if you have a hos­pi­tal plan with a lump sum ben­e­fit for hos­pi­tal­iza­tion, it pays to check the con­di­tions that must be met for the ben­e­fit payment.

If the pol­i­cy pays by sub­mit­ting a hos­pi­tal invoice, there shouldn’t be an issue. But if the pol­i­cy requires the EOB and a true inpa­tient charge, your claim for a sched­uled surgery with overnight recov­ery may be denied. These details are depen­dent on the Evi­dence of Cov­er­age (EOC). This doc­u­ment is long and bor­ing. Your Employ­ee Ben­e­fits Advi­sor can help deter­mine how your poli­cies pay in these cases.

Tak­ing these ini­tial steps will make a hos­pi­tal stay now or in the future more man­age­able. While you focus on treat­ment and recov­ery, the billing and claims will be eas­i­er to track and deal with. This will allow you to advo­cate for your­self and reduce the stress of deal­ing with an already dif­fi­cult situation.

 By Matthew Sohn

Orig­i­nal­ly post­ed on North­bay Biz

Matthew Sohn is a senior ben­e­fits advi­sor at Arrow Ben­e­fits with more than 21 years of expe­ri­ence. He is also an expert in Medicare and applies his MIT engi­neer­ing to ana­lyze and design cost-effec­tive ben­e­fits pro­grams. Con­tact him at [email protected], or call (408) 384‑8150.