Helping Patients Sort Out Hospital, Independent Provider Bills

January 19, 2017

Ron Stahl

Coming to the hospital is usually something most of us desire to avoid, except for the occasion of childbirth. However, even then we can get surprised by the number of different bills we receive from different medical providers. My daughter recently gave birth to her first child and even though she grew up in a healthcare family, she was totally unaware of the number of bills she would be receiving. Like many people, she thought she would be responsible for paying her obstetrician as well as the hospital for the care she received. Unfortunately, most healthcare systems are comprised of several different providers who are each responsible for billing and collecting for their services. So let’s look at what my daughter learned as a result of giving birth to her first child.

First off, we need to understand what insurance pays and what it may not.  Most insurances have what are called co-pays and deductibles. These are very different. Co-pays are payments that are due at the time of the service. Most physician offices collect these at the time of the office visit.  In the case of obstetrics, there may be a one-time co-pay or there may be a co-pay for each visit.  In addition, the patient is responsible for covering any deductible that the insurance plan may have. Like automobile deductibles, the patient is responsible for the amount of the deductible before the insurance company will pay. 

So, back to my daughter. She completely understood the need to pay any co-pays for her physicians and knew she would be responsible for the hospital charges. However, like many patients, she did not realize that any services by radiologists (reading any x-rays, ultrasounds, etc.), anesthesiologists (epidural placement, etc.), or pathologists (examination of the placenta) would create new and additional bills for services. Since these physicians are independent providers who have a contract with the hospital to perform services, their costs are not covered by any hospital bill. As you can imagine, this was a huge learning experience for my daughter.

Many patients do not have the understanding of these relationships nor do they realize all of the potential bills they may receive for care given during any hospital stay. At Wilson Medical Center we have staff who can help patients understand these issues. If you have any questions about billing or insurance, call Patient Financial Services at 252-399-8151.

Our desire is that you receive high quality safe patient care and that you are knowledgeable regarding both the care you receive as well as what your financial responsibility will be. Please be informed and don’t be afraid to ask questions of any of your healthcare providers.  Knowledge is powerful.

Ronald Stahl, M.D. is the chief medical officer at Wilson Medical Center.