If You Have Insurance
Your health plan can give you the most
accurate price for medical services
law requires physicians, hospitals and health plans to provide consumers with a
good faith estimate of the cost of their care.
Over 94 percent of Minnesotans have insurance and that number is expected to
increase as the Affordable Care Act is fully implemented. Because health
insurers negotiate different payment rates for services with each health care
provider, including hospitals, physicians and clinics, the best way to compare
prices you will pay at your local hospital is to contact your own insurance
final out-of-pocket costs can be higher or lower than your neighbor’s — even
when you’ve undergone the same procedure. That’s because health insurance plan payments
vary, and insurance plan benefit levels are unique to each plan. In other
words, even if you and your neighbor both have the same insurance company, your
benefits may be different – insurance companies sell policies with different
levels of benefits to different employers and through MNsure, the state’s
health insurance exchange. Other factors that impact price may be complications
or other health conditions you may have.
is there sometimes more than one bill for a single hospitalization?
should also be aware that — depending on the medical services you need — you
may receive several bills for your hospital services — from the hospital, the
surgeon, the anesthesiologist, the pharmacy, the radiologist, or the
pathologist, for example, depending on what services comprise your treatment.
Minnesota law protects patients from surprise bills
Surprise bills may occur when a patient receives care at an out-of-network hospital or a patient receives care at an in-network hospital but one or more of the providers working in the hospital is considered out-of-network by the patient’s health insurance company. A state law effective Jan. 1, 2018, limits a patient’s financial responsibility to the amount they would have paid if they had received in-network services, ensures patients have access to emergency care and requires a health plan and nonparticipating provider to negotiate payment. If a payment agreement cannot be reached by the health plan company and the nonparticipating provider, either party may elect to refer the matter to binding arbitration.
Your insurance plan can tell you what
the hospital’s price will be for all of your services as well as what your
out-of-pocket, co-pay and deductible will be.
is a list of Minnesota commercial insurance companies and main customer service
Blue Cross and Blue Shield/Blue Plus of Minnesota
Metropolitan Health Plan
Sanford Health Plan of Minnesota
Note: If you are insured, you should contact the
number on your insurance card. This is not a complete list of insurance
companies. For example, there are national insurance companies through which a
federal employee residing in Minnesota may have insurance. A business person
who resides in Minnesota but whose company is based in New York may also have a
different insurance company, for example. In addition, there are Medicare
Advantage plans or Medicare supplemental plans that are not listed here.
it is important to know that hospitals are not allowed to get together to set
prices. That would be a violation of federal and state anti-trust laws.