If you have been in the emergency room or hospital lately, you have probably received a bill that was much greater than you imagined it would be. If you have insurance contracted with the hospital or if you have Medicare, you will see an initial bill and then a bill that shows the discounted price. This price will be used to determine both your and the insurance company’s responsibility.

Your responsibility will depend on the amount of your co-payment and deductible. The deductible is the amount you have to pay up front before the insurance pays anything. After the deductible amount, you have a co-payment, which means you pay a percentage and insurance pays the remaining balance. The co-payment and deductible are not determined by the hospital but are the arrangements you have with your insurance company. The portion owed by you is just as important as the portion owed by the insurance company. Together, the insurance payment and the patient payment complete the bill. Some people are fortunate to have more than one insurance, which may pay even more of the total or perhaps all of it.

Regardless of your situation, the bill will not be small. It is therefore important to do everything you can to stay out of the hospital or emergency room. I was amazed to hear comments from a radio announcer in Columbia. He told a caller that she could go to the emergency room anytime she had any medical need, emergency of not, and said it was federal law that the emergency room had to see her and couldn’t charge her.

I don’t know where people get these ideas. The emergency room will try to see anyone who comes there, but there is nothing that says they have to do it for free. Usually, this is very expensive, compared to a doctor’s office visit. Besides, the emergency room is for emergencies, and someone who doesn’t have an emergency could be waiting for a long time. Non-emergencies also make it difficult for legitimate emergencies to be seen in a timely manner.

Avoiding a doctor’s visit or failing to take medications may also seem to reduce spending, but it is very short-sighted. Eventually, a hospital visit will be the end result, and you could owe more in a couple days in the hospital than from 100 or more office visits. I have many patients with various types of heart disease that could become a problem again at any moment, but those who take their medications, come to their regular visits and change their lifestyle to help their disease rarely have to be in the hospital. Even the most expensive testing at my office or any other doctor’s office will not cost anywhere near what a day in the hospital will cost.

Of course, the hospital is available to take care of illness that has gone beyond what can be done at home or in the doctor’s office. These beds, however, should be occupied by people who tried to stay out, but the illness was just too bad. It is unfortunate when someone fails to do their part to stay out of the hospital and takes up a bed that someone else might need. A chunk of the savings expected with health care reform is to get people insurance that will help them get the preventive care needed to stay out of the hospital. However, the insurance will not be free. The cost of most preventive care is actually less than the anticipated cost of the insurance. But if people are unwilling to pay for preventive care, why do we expect that they will pay for insurance?

It is a good idea for people to say they are willing to invest time and effort in their personal health. Even if hospital care is reduced to half-price, you still may not be able to pay the bill. Quality health care cannot be provided without some cost. Get involved in your own health, and hopefully we can help get quality health care for everyone.

The hospital is a huge resource and there whenever you need it, but it is definitely a situation of pay now or pay later.

Dr. John Hutto is a cardiologist at Orangeburg Cardiovascular Clinic and the Regional Medical Center in Orangeburg.

This entry was posted on Monday, September 28th, 2009 at 4:31 pm and was written by House Call. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.