Health insurance and hospital stays

[Qacer]

I wanted to find out from those who have experienced hospital stays and used their health insurance overage to pay for it.

My insurance states that the network provider has to precertify them for any services, supplies, etc. rendered. Part of my insurance clause states that it will only cover rooms that are equal to or less than a semi-private room charge.

If I get admitted to a hospital and the hospital puts me in a private room without giving me an option between private and semi-private, is it safe to assume that the use of the room has been approved for coverage?

I'm not sure if a hospital is required to tell an insurance company the type of room that I will be using during the precertification process.

Anyone experienced hospital stays before using health insurance?

I'm planning on calling my insurance provider when they are open during the weekday. But I'm curious now, so I figured I'll try to fish some answers. Thanks!

 

[nanette1985]

When I was in the hospital I went in through the ER, and it made a huge difference in the insurance coverage - I didn't need precertification, Aetna accepted whatever the doctors ordered, all tests were covered and so on. Also, be aware of balance billing, which is illegal, at least here in NJ. The hospital tried that, Aetna got down on them big time.

However, for non-emergency stays, Never Assume Anything. Check and double check with your insurance, and don't take a verbal assurance. Get it in writing. Get everything in writing.

Best of luck and I hope whatever you need hospitalization for isn't too serious.

 

[PhoKingGuy]

what company do you have? Kaiser is very straight forward about this, some arent.

 

[Qacer]

Routine exam this week lead to an admission at the hospital. Been here since Tuesday. With too much going on, I was only able to read through the insurance documents last night. I did call the insurance company on Wednesday, but only to make them aware of my current situation and asked if I needed to do anything else. They said that the hospital already contacted them and that I didn't need to do anything else. I didn't get to ask the specifics then.

I've got Aetna HMO, by the way.

That's a good point about the paper work. I will review the paper work that the hospital gave me. I don't remember seeing any break down on estimated charges there, though.