Before you enter the hospital

• Understand your insurance plan – deductibles, co-pays, maximum payouts, exclusions. Call ahead to the insurance company, hospital and doctor’s office to get estimates of the cost and what your share will be.

• Know which hospitals and doctors are “in-network,” meaning they have contracts with your insurance company to provide care at set rates. “Out-of-network” providers have not agreed to set rates and may charge more. Your insurer may require higher co-pays and co-insurance if you don’t use the network.

• If you’re uninsured, look up the hospital’s charity care policy online or ask a hospital financial counselor to explain it. Links to charity care for many N.C. hospitals are at www.ncha.org/issues/community-benefit.

• If you’re uninsured or using an out-of-network hospital, negotiate for a discounted rate similar to what insured patients are billed. Pat Palmer, founder of Medical Billing Advocates of America, recommends asking for 35 percent to 50 percent off hospital “charges.”

• Another suggestion is to ask for the Medicare rate plus 25 percent. “That’s what we kind of start with,” Palmer said.

• If you’re using a network hospital, find out if it will be using any providers, such as anesthesiologists or laboratories, that are out-of-network. If so, ask your insurance company to pay in-network prices for out-of-network providers if you have no control over the choice. Ask for in-network providers, if possible.

When you’re admitted to the hospital

• Bring a family member or friend who can act as your advocate.

• If you haven’t already asked about charity care, ask a hospital representative how to qualify.

• If you haven’t already, ask if any of your care providers, such as the anesthesiologist, are out-of-network. If so, ask the doctor to accept your insurance company’s out-of-network reimbursement.

• If the doctor refuses, ask your insurer to send the reimbursement check to you instead of the doctor. The doctor may prefer to receive a lower out-of-network reimbursement directly from the insurance company rather than “fight you to get a penny,” Palmer said.

When you get the bill

• “Do not pay without getting a detailed, itemized statement,” said Palmer. Otherwise, “You really have no clue what you’re paying for.”

• Review the bill for errors. Sheets, gloves, etc, should be included in an overall room charge, not priced separately, Palmer said.

• Watch for drugs that you didn’t receive. Pay attention to hourly fees for the operating room and recovery room. Palmer said patients should not pay for time spent waiting in recovery “if nobody was available to take you to the room. That wasn’t your problem that they weren’t staffed to do that.”

• If you need help deciphering the bill, ask for a consumer advocate through Palmer’s organization or other local agencies.

• Match the bill to the insurance company’s “Explanation of Benefits.” Many people discard this document because it’s stamped “Not a bill.” Wait for your doctor or hospital to bill you for the amount you owe after your insurance has paid.

• Ask the hospital if they offer a discount for immediate payment, a common practice.

If you get threatening calls or letters from the hospital or a collection agency

• Do not ignore their letters or calls. Delay can result in being reported to a credit agency.

• Hospital officials say they’ll help set up payment plans, and some experts say it’s better to work out a plan directly with the hospital than face additional fees or penalties from an outside agency. If you pay the hospital directly instead of the collection agency, mail or fax proof of payment to the collection agency.

• If you dispute your bill, make your case in writing to the hospital. “Any time you dispute something in writing, they are obligated to answer in writing,” Palmer said. “The account is supposed to be put on hold until the dispute is resolved…. I’m not saying don’t make a good faith payment if you know you owe something.”

If a collection agency takes action

• Know that this can affect your credit rating. Many people find out only later when they apply for a car loan or mortgage.

• If appropriate, file a complaint with the Better Business Bureau or the state attorney general’s office.