How to Plan Ahead for ER Visits: Reduce Stress and Control Medical Bills | Ep. 16

When a loved one is sick, the last thing you want to stress about is which hospital will cost less. In this episode, Melody answers a question from a listener who struggles with this exact problem and lays out a simple, proactive plan you can follow before an emergency happens.

Featured topics in this episode:

• The critical difference between "in-network" and "out-of-network" hospitals is that choosing the wrong one can significantly impact your final bill.
• How to understand your specific insurance costs for an emergency, from the initial ER co-payment to the potential fees for a hospital admission.
• An insider's tip on using the government-required "pricing transparency" data on hospital websites to compare costs before an emergency occurs.

What You’ll Hear:

• [00:55] A listener's question about choosing a hospital during a family medical emergency while worrying about the potential cost.
• [02:00] Step 1: How to verify if a hospital is "in-network" with your insurance plan by checking either the insurer's or the hospital's website.
• [03:35] Step 2: Understanding your personal costs, including typical ER copayments and what you might owe if a patient is admitted.
• [05:15] Step 3: How to find and compare hospital pricing on their websites to see if one facility charges significantly more than another.
• [06:30] The importance of choosing in advance, so you are not making a financial decision under the stress of a medical crisis.
• [07:05] A special note on why financial concerns between hospitals are less of a factor for patients on Medicare.

Want to Ask Melody? Visit: https://melodymulaik.com/ASK Don’t forget to subscribe so you won’t miss an episode. If you've ever worried about a surprise ER bill, this episode is a must-listen.

Transcript

Speaker 2: 0:13

Hello everybody and welcome to this episode of Take Care with Melody. I appreciate you taking the time to join me as we talk about the challenges of getting the healthcare you need, today. And with that in mind, got a great question from Kirsten, want to bring to the group. It feels like we're always ending up in the ER for something. When my son was throwing up and it wouldn't stop, or when my mom couldn't catch her breath and ended up with lungs filled with fluid. I'm just trying to get them the care they need, but I'm also stuck wondering which hospital to go to. Am I going to get charged the same no matter where I take them? Or one place ending up costing me way more than another? It's hard to think about money when your kid is sick. But it's always in the back of my mind. What a great question and what a very on point issue because yes, when your kid is sick, you're stressed. You want to get'em the care they need. You're not thinking about do I go to this hospital versus this hospital? What's that money going to be? What does that look like? Let's take a scenario where let's say, you're sitting in the middle of two hospitals, and both of them are 15 minutes away. And we're going to use, for today's purposes, we're going to say the care is the same. Both are great. They both have excellence emergencies rooms, no issues with care. And it's really coming down to, okay what's my financial situation if I go to hospital A versus hospital B. Well, again, we want to look at these things prior to being in that moment of stress. So, the first thing that we're going to want to know is do both of those hospitals take my insurance? That's called being in network. So, if they take your insurance, that means that your insurance company has put a contract in place with that hospital to say, Hey, we're going to send patients over to you and you're going to provide coverage for those patients. So, I want to make sure that my insurance is taken by this hospital. So, a couple ways I look at that. One, I log into my insurance company's website and I look at my benefits. And hopefully, they should have a search function where you can pull up their physicians and their hospitals that are in their network. Most of the insurance companies do allow that. The other thing you can do is actually go to the hospital's website and usually they will have a place where you can put in information to make sure that it's covered. So, again both sides. Let's just make sure that those hospitals are in network. If they're in network, that's good. That's a really good piece with it. If they're not, let's say we find one that quote says out of network. It's important to know that because what are you going to be required to pay if you go to a facility or hospital that is out of network. If you look back to looking at your insurance coverage, some insurance coverage plans say, we don't provide any payment for out of network. That's a choice. Sometimes those plans may cost you a little bit less money because they know that they're not going to provide any out of network care. So, if your plan says, Nope. We do not provide coverage for out to network. You're not going to want to go to that hospital if you can avoid it because you're going to have a more significant financial responsibility. Then, you might find that your insurance plan says, we do provide coverage for out to of network, but we charge you more money. So, it might be a situation where you look at in-network versus out network and you could see a higher percentage or higher amount of money that you are going to have to have out of pocket. So, know that in advance of what's again, what out of network or not out of network. So, that's the first and most important thing that you want to know. Secondly, you're going to want to know what is it If you go to the emergency room? How are you going to be paying for the care that you get? And what I mean by that is most insurance plans now have a copayment even for the emergency room. And it's usually a pretty high copayment, anywhere from 350 to 450. And that's usually probably the range that I see. And they're wanting to make sure that if you're going to go to get emergency care, you know that it's going to cost you$450 just to walk in the door. Whether that's a minor thing that's being dealt with or it's a major thing, you're going to be paying that$450 with that. If both of your hospitals are in network, you're going to pay that$450 no matter if you go to hospital A or hospital B. So, there's no difference. Okay. But the other piece that you want to look at with your insurance coverage is what happens if somebody needs to be admitted into the hospital. So, let's say you've got a situation, again, your son is throwing up. They decide to admit them for more treatment, more testing, whatever the reason they decide to admit them into the hospital. What does that look like for you? So, you may find, as you look at your benefits, if there's an admission, some insurance plans say you're going to pay$500 for an inpatient admission. If that's all you pay, again, it doesn't matter, hospital A versus hospital B. But you might be required to pay a percentage of fees after you've met your deductible. And if that's the case and you're going to be paying 10% or 20%, which is pretty common, you might say, okay, I don't even know what that number's going to be. And unfortunately, no one can really predict that in advance. But what you can do in advance is determine which hospital are they charging about the same for the services they provide or is one charging more than the other? And how do you find that out? You go to their website. One of the requirements is that hospitals must publish their pricing on their website. They call it pricing transparency. And that's something that the government requires them to do. Now, that said, it doesn't mean that the information on the website is a hundred percent accurate, quite frankly, and it doesn't mean that's exactly what your charges are going to be, but what it does tell you is; is hospital A charging a lot more than hospital B? That's just an indication that maybe when you get your bill, you may wind up owing more. I'm not saying you do, but you potentially might be owing more money if they're charging more. So, I would look and if their fees are about the same for services and you can pick anything. You can pull it up and just look at any types of services that they do and just say, okay, I'm going to compare, a knee replacement of hospital A versus B, or pick anything and just look at it. Again, if it's about equal, then I would say your financial experience is going to be the same. But if I see hospital A, wow, they charge twice as much as hospital B. Then, that lets me know, okay, care being equal, I'm going to go to hospital B. And I've made this decision not when my son is throwing up in the backseat of the car. But I know in advance, if I have to go to the emergency room, I'm choosing hospital B because I think that's going to be a better out of pocket for me, having to pay the bills afterwards. So, key things to know is the hospital in network or not? If it's in network, good. I have my copayment that I'm going to pay. It's going to be the same. I need to know what am I going to be asked to pay if there is somebody who needs to get admitted to the hospital. And is there really a difference in what those two hospitals are charging? And if there's not, I got two great options. I go to hospital A or hospital B. If I see that there is a difference, then I've already made the decision to go to hospital B in this scenario, and I'm doing that stress free. One thing that I will just add at the end, when we talked about mom being on Medicare, just to mention that. Medicare experience really doesn't vary financially that much between hospitals. So, I don't really worry about that. I make decisions about where to take mom based on, where her doctors are or where I think the best care will be or even what her preference is with it. I don't worry about that for Medicare. All things being equal. Again, it's more on the commercial side. So, hopefully this helps you as you go ahead and make those plans in advance prior to being in that stressful situation as you're taking care of your son, as he's throwing up. And we're ready and prepared to go to the right hospital to meet our needs. So, that wraps up this episode of Take Care. Please go on like the podcast, share with your friends and please let me hear from you. In the meantime, take care.