Consumers are paying more attention than ever to their hospital and health care bills.

It's no wonder. Household budgets are tight at a time when health insurance plans are asking you to pay for a bigger chunk of your health care.

Most Americans have plans that carry deductibles of $1,000 or more. Many plans have copays and co-insurance as well.

Health crises are by their nature unplanned and difficult to budget for. But as much as possible, you want to understand what you'll owe for your health care before that bill lands in your mailbox. Here's our advice about how to estimate health care bills ahead of time.

1. Look for a cost estimator at your insurer's website.

Four out of Pennsylvania's five largest health insurers have estimators.

With most estimators, you enter information about the health care services you need. The estimator gives you your out-of-pocket costs based on:

  • Your plan information (deductibles, copays, etc.)

  • The insurer's payment rates for different providers (doctors, hospitals, etc.)

Some estimators let you compare how your out-of-pocket costs would stack up for different providers.

2. Check to make sure the doctor—and everyone else—is in network.

The "in-network" versus "out-of-network" issue is one of the biggest reasons for unexpected, and unexpectedly high, health care bills. To avoid surprise bills, do your best to make sure that everyone involved in your care (doctors, hospitals, labs, therapists) is part of your health plan's provider network.

Start by checking your insurer's website. Many insurers let you search for your plan's in-network providers.

Check again at the doctor's office, lab, outpatient center, or hospital to make sure they are in your plan's network:

  • If your doctor is sending blood or another specimen out for testing, ask which lab. Make sure the lab is in network.

  • If you are getting ready for an operation or medical procedure, ask about all the services involved (such as an assistant surgeon and anesthesia) and whether they are in network.

  • If "out-of-network" providers are likely to be part of your care, ask if an in-network provider is available. Call your insurer and ask for help if in-network options are unavailable.

Does your health plan have one of the new tiered networks? With these plans, you pay more (or less) depending on the tier, or group, of hospitals and doctors you choose.

If you have one of these plans, stick to health care providers in your tier if you want to keep your bill as low as possible.

3. Make money part of the health care discussion.

When necessary, we—you and health care professionals too—need to make financial concerns part of the discussion about the care you need.

Pennsylvania hospitals are ready to talk. More than 70 percent have adopted these new principles and guidelines for billing and financial services. The guidelines outline how hospitals should explain to patients what they will owe for their health care.

We have a ways to go. In a recent study of outpatient visits, costs were discussed during only a third of visits. But about half the time when financial concerns were raised, doctors and patients found ways to lower out-of-pocket costs.

It may take more time, energy, and phone calls than we'd like. But you can take steps to understand, plan for, and even lower what you'll pay for your health care.


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