Understanding Hospital Charges
Medical billing can be confusing. From health insurance to hospital charges
and physician fees, there are a number of factors that impact what patients
pay for services and procedures. Before your upcoming hospital visit or
scheduled procedure, the best thing to do is to talk with a Baton Rouge
General team member who can provide you with an estimate of what you will
owe. Their estimate will be based on your health insurance coverage and
the contracted rate your insurance company has with the General, called
a contracted fee schedule.
Get an Estimate
Before your visit, it’s a good idea to get an idea of how much your
procedure will cost and what you will owe. Visit us online to
get an estimate or call (225) 381-6276.
It Starts with Health Insurance
If you have health insurance, the hospital billing process begins when
Baton Rouge General receives your insurance policy information, including
policy number and the name and address of your insurance company. Once
we receive this information, Baton Rouge General files a claim with your
insurance company on your behalf, notifying your health insurance company
of your upcoming healthcare visit or procedure.
Your insurance coverage has a lot to do with the final amount that you
will pay. Baton Rouge General has contracts with insurance companies that
determine the amount that will be paid for certain procedures, often making
out-of-pocket payments lower than they would be without the contract.
Any insurance adjustments that you see on the Explanation of Benefits
(EOB) change the final amount that is billed from the original
hospital charges (hospital charges and average diagnosis-related group (DRG) pricing) to
the price that your insurance company and the hospital have agreed upon.
Not everyone with Medicare has the same type of coverage. And while Medicare
will pay for many of your healthcare expenses, there may be some that
aren’t covered. The best way to be sure of what your Medicare plan
covers is to call 1-800-MEDICARE, or visit the website at
Contact your local Medicaid office at 1-888-544-7996, or visit the Louisiana
Department of Health to determine all the factors affecting your financial
responsibility. In general, Medicaid recipients are not responsible for
any portion of their hospital bill.
Patients without insurance are billed five days after they are treated
at Baton Rouge General for unscheduled events. Your bill will be based on the
hospital chargemaster pricing which is a comprehensive listing of services and procedures and
their cost. Patients without insurance are eligible to apply for
Explanation of Benefits (EOB)
You should receive an Explanation of Benefits, or EOB, from your insurance
company within four to six weeks after Baton Rouge General files your
claim. This will highlight the services that Baton Rouge General is billing
for, the amount paid, the amount adjusted, and the healthcare provider
that treated you. The EOB will also provide information on your balance,
which could include co-pays, deductibles, or co-insurance.
Your health insurance coverage has a lot do with the final amount that
you owe the hospital. You will not receive a bill from Baton Rouge General
until your health insurance company has paid their portion of your bill.
Questions about your bill?
Keep in mind that every insurance plan is different. Some plans require
co-pays, some include deductibles, and some require both (or neither!).
The answers below are intended to provide basic, generalized information
about how many insurance plans work, but they are not universal.
What is a co-pay?
An upfront payment for your hospital visit required by some insurance
plans. Examples of copays are set amounts paid at ER visits or doctor’s
What is an Explanation of Benefits (EOB)?
A document from your insurance company that outlines what they are paying
on your behalf.
What is a deductible?
How much of your costs your insurance plan expects you to pay in a year
before your plan starts splitting the costs.
What counts towards my deductible?
It depends on your insurance plan. Usually most out of pocket medical
expenses such as copays, payments on medical bills, and prescriptions
count towards your deductible.
What is co-insurance?
The portion of care expenses you are responsible for after you have met
your deductible. This amount is a percentage of the amount that was billed
to your insurance company based on the contracted fee schedule.
What is an out-of pocket maximum?
This is the most you will pay each year for medical expenses per your
agreement with your insurance company.