Preparing for Hospitalization: What to Expect

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.