Understanding your Hospital Bill
When you are treated at Glens Falls Hospital or any hospital, you or your insurance provider will receive separate bills from the hospital itself and from any physicians involved in your care. Some of these physicians may be employed by the hospital, others may work for private practices in the community.
The hospital bill will include charges for the use of hospital equipment, supplies and facilities, as well as any services provided by hospital employees other than physicians.
Each physician (or physician practice) involved in your care may issue a separate bill for services provided, such as consultations, procedures and evaluations of medical tests.
Glens Falls Hospital is a participating provider in many health insurance plans. You can find a list of those plans here but we encourage you to check with your insurance company’s member services department to verify coverage. Some health plans use smaller provider networks for coverage of certain products and services, so exclusions may apply.
Physicians involved in your care in the hospital may or may not accept the same insurance plans as the hospital, as follows:
- Physicians employed by Glens Falls Hospital accept the same plans as the hospital;
- Private practice specialists may not accept the same plans;
- Private practice specialists with contractual agreements to provide certain services (anesthesiology, pathology, radiology) within the hospital may not accept the same plans.
We encourage you to check with your insurance company if you have questions about insurance coverage. Click here to view a list of Glens Falls Hospital Contracted Services.
Hospitals are required by law to make available information about standard charges for services they provide. These charges represent only the standard charges provided by a hospital. It does not provide a quote or guarantee of actual charges, e.g., how much it will cost for a specific patient’s care. It does not account for any variables in a patient’s medical condition, complications, length of stay, use of laboratory tests, pharmaceuticals, etc. It also does not account for whether a patient has health insurance or the availability of other discounts. Patients should always contact the hospital’s financial services staff for specific information. Download the Standard Charges (.xlsx).
Standard charges by DRG can be viewed on the CMS website: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html
For more information on Glens Falls Hospital’s charges, contact our Financial Assistance Office at 518-926-5111.
If you do not have health insurance, or face difficulties in paying your portion of a hospital bill, you may be eligible for assistance. To learn more, click here or contact our Financial Assistance Office at 518-926-5111.
Understanding Inpatient vs. Outpatient Observation Services
Even if you stay in the hospital overnight, you might still be considered an outpatient.
The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need two or more nights of care in the hospital. The attending physician must order such admission and the hospital must formally admit you in order for you to become an inpatient.
Sometimes, however, a doctor may decide to keep you in the hospital as an outpatient for a period of time and he or she may order observation services. When you are an outpatient, you generally do not meet the clinical criteria to be an inpatient, even though you are in a regular hospital bed. The observation services that you receive as an outpatient may look and feel exactly like inpatient services, but costs and insurance coverage will differ. These stays are usually shorter hospital stays that will provide testing, treatments, as well as care by a physician and other hospital staff. When you are being discharged from outpatient status, any further testing may need to be done in the outpatient setting.
Benefits vary greatly for patients with private insurance – it is important to call your insurance company to make sure you understand your co-pays, co-insurance and covered services. If you are a Medicare patient, being on outpatient status may impact what you pay in the hospital and what type of coverage you have when you leave the hospital (see below).
Outpatient Observation Insurance Coverage Under Medicare
If you are covered by Medicare, either traditional Medicare or a Managed Care Medicare Advantage Plan, being an outpatient may impact what you pay in the hospital and what type of coverage you have when you leave the hospital.
When designated as being an outpatient, you will receive a notice titled “Medicare Outpatient Observation Notice,” which provides an overview of coverage. You can read a copy of this notice here.
If you have any questions about your outpatient services, ask the hospital staff member giving you the notice or the doctor providing your hospital care. You can also ask to speak with someone from the Glens Falls Hospital Care Management department, or call 800-MEDICARE (800-633-4227). TTY users should call 1-877-486-2048.
Provider-Based Services & Billing
Glens Falls Hospital owns and operates a number of physician practices in the region which are designated as “Hospital-based” or “Provider-based” outpatient clinics under federal Medicare rules and by some private health insurance companies. When we care for someone at these provider-based clinics, we issue two separate bills— one bill for the physician’s services, and another bill to cover our costs of running the facility. Depending on a patient’s health insurance coverage, this may result in higher out-of-pocket costs from co-pays and deductibles.
Glens Falls Hospital understands that federal billing guidelines are complex and patients may have questions. For help understanding charges associated with Glens Falls Hospital, contact the Patient Accounting team at 518-926-5111.