Consumer Information 

The health care system can sometimes be confusing. But you can minimize the confusion if you take the time to become an educated health care consumer.

Understand your health insurance coverage.
Many health care consumers don’t take the time to understand their health insurance coverage before they incur medical expenses. Review the plan materials. You should review the plan materials frequently, and ask your employer or insurer if you have any questions. The time to address any confusion is now, not when you are facing a stressful medical situation and may have to make decisions quickly.

Understand your medical condition and the proposed treatment.
Being an informed patient includes learning about your medical condition, the medical procedure or treatment that has been recommended, and suggestions on next steps. Take the time to research the medical condition and discuss questions with your physician.

Consider quality-of-care issues.
Colorado hospitals are committed to sharing information about the quality and safety of the health care services that they deliver in their communities. To see how Colorado hospitals compare on various quality measures, visit http://www.cohospitalquality.org/.

Understand how much you will be expected to pay before receiving hospital care.
If you have health insurance, contact your insurer and:

• Explain what is to be done, when it will be done, and by whom (hospital/physician).
• Confirm that the procedure and the provider will be covered.
• Ask if there are any limitations to the coverage.
• Ask what the expected out-of-pocket costs will be.
• Ask if the out-of-pocket costs would be less if a different hospital/physician was involved.

The Colorado Hospital Price Report website provides information on billed charges for various types of inpatient care. However, lower hospital charges may not necessarily mean you will pay less out of your pocket. That is why it is important for you to contact your insurer.

Many commercial insurance companies and employer self-funded plans require enrollees to seek care exclusively from a specific group of hospitals and physicians in order for the service to be covered. This group of hospitals and physicians is often called a “network.”

Other insurers and employers will cover the services of hospitals and physicians that are not in the network, but will require patients to pay a higher percentage of the cost if they use the services of non-network providers.

If you are required to use the services of physicians who are in your insurer’s network to receive the highest level of coverage, ask your insurer for the names of the anesthesiologists, pathologists and radiologists in the network who provide services at the hospital. These are the types of physicians who may provide services related to your inpatient stay or other hospital service, but it’s possible you may never personally interact with them. As with surgeons, they are often not employees of the hospital, so their services will probably be billed separately. If they are not part of your insurer’s network, you may be responsible for a larger portion of their fees or all the fees.

If you do not have health insurance, contact the hospital and ask about its payment policies. Hospitals have charity care policies that offer partial or total fee reductions, or payment plans, to patients who have a financial need. While policies will allow consideration of individual circumstances, financial assistance provided by hospitals is not a substitute for personal responsibility. Patients are expected to provide complete and accurate information about their financial status and to pay for their care based on their individual ability. In this way, applications for charity care can be accurately assessed, assistance can be managed fairly, and hospitals can meet their mission to provide care to all patients.