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How Does My Health Insurance Work At The Hospital?

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For more information about the Affordable Care Act, visit CBSSeattle.com/ACA.

The Affordable Care Act (ACA) requires that all health insurance policies cover 10 essential benefits. These essential benefits include coverage for care at a hospital, whether it is emergency treatment, inpatient care or outpatient surgery. Check with your insurance company’s provider directory to determine which hospitals are in your health plan’s network. You will find the provider directory at your insurer’s website or included with the materials you received with your policy.

If you receive care at a hospital outside of your plan’s network, you may be required to pay a larger portion of the bill. Be aware that some Health Maintenance Organization (HMO) or Exclusive Provider Organization (EPO) health plans will not cover any portion of a charge from an out-of-network provider leaving you to pay the entire cost.

Note that if your doctor schedules you for a procedure at a hospital, his or her office usually will verify that the facility is covered by your health plan. However, you may wish to confirm this with your insurance company to avoid an unexpected bill. When you check into a hospital, you must produce your insurance card. This will provide the hospital with the information they need for billing.

If you go to the nearest hospital during an emergency, your insurance will cover it.

If you have an emergency, a medical issue that requires immediate care to protect your health, you may go to the nearest hospital, even one that is not in your health plan’s network. The ACA requires that your insurer covers emergency treatment without any additional cost over what you are required to pay at an in-network hospital.

In-patient care is when you are admitted to the hospital, assigned a room and stay overnight. With outpatient care, which includes day surgery, you visit a hospital for a procedure and return home once the procedure is completed. Typically, the deductable and co-payment amounts, the portion of the hospital bill you must pay, are different for inpatient and outpatient care. Refer to your insurance policy to determine how much of a bill you must pay out-of-pocket.

The hospital’s bill is just one of the costs associated with receiving hospital care. Your insurance company will be billed separately for the doctor’s fee and the anesthesiologist’s fee, if you were anesthetized. You may be responsible for a portion of these fees depending on your health plan’s co-payment and co-insurance requirements.

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.

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