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 estimate of how much your procedure will cost and what you will owe. Visit us online to get a quote 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.

Insurance

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.

Medicare

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 (800) MEDICARE, or visit the website at mymedicare.gov.

Medicaid

Contact your local Medicaid office at (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.

No Insurance

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 Financial Assistance.

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 Bill

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?
(225) 819-1000
customerservice@brgeneral.org

Insurance FAQs

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 office visits.

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.