Hospital stays can be expensive and prices vary widely, regardless of the quality of care. Take New York City, for example. Patients might pay $7,500 for four days in the hospital—just the hospital admission, no medical services—or more than $23,000, according to Healthcare Bluebook, a privately owned company that allows consumers to look up fair market prices for various medical services, including hospital costs.

Private insurance companies pay discounted rates they negotiate with hospitals; privately insured patients are billed based on the rates their insurers negotiated and the terms of their insurance coverage. That makes hospital costs confusing, especially because price information has rarely been available to consumers. But that is changing, says Bill Kampine, co-founder of Healthcare Bluebook.

Do Research Online

Some states have websites that allow patients to compare the average amount that insurers pay for common medical procedures at one hospital versus another. Some websites, including NewChoiceHealth.com, HealthcareBluebook.com, and FairHealthConsumer.org, also allow price comparisons. And many hospitals now provide cost estimates that allow patients to view their options in advance.

Be Knowledgeable

To make smart decisions about health care purchases, you need to understand your health plan, says Robin Gelburd, president of FAIR Health, an independent nonprofit group that collects and manages health care claims data. For example, whether you choose the hospital that charges $7,500 or the one that charges $23,000, your copay and deductible amounts will be the same. But if your health plan requires 20 percent coinsurance, you will be responsible for 20 percent of the total cost after you reach your deductible.

For other ways to keep hospital bills as low as possible, follow these tips.

1. SHOP AROUND. Some national health plans, including United, Anthem, and Cigna, have an online and mobile cost estimator tool that lists physician quality information, customer satisfaction ratings, and estimates for out-of-pocket costs for a specific service based on the doctor, clinic, or hospital you choose. If your health plan doesn't have a cost estimator, look for free ones online such as FAIR Health, Healthcare Bluebook, and Medicare's Hospital Compare. FAIR Health reports the in-network and out-of-network prices of a specific health care service in a given zip code; Healthcare Bluebook provides a range of prices for a service and highlights what it calls a "fair price." Medicare's Hospital Compare site shows whether Medicare pays a given hospital more or less than the national average for certain procedures. Use that information to evaluate cost estimates that you request from in-network hospitals.
2. STAY IN NETWORK, IF POSSIBLE. For non-emergency care, call your health plan provider to make sure that the hospital and physicians you plan to use are in its network. Tests like MRI scans may cost twice as much out of network as they would in-network, says Gelburd. Emergency care is trickier because even if you go to an in-network hospital, the physician who treats you might be out of network. If you get a bill from an out-of-network physician-say, an emergency physician, radiologist, pathologist, or anesthesiologist-at an in-network hospital, ask your health plan to help negotiate lower out-of-network charges or waive the charges completely. Some states, like New York, now offer protection against balance billing; check the laws in your state.
3. ASK FOR A SEMI-PRIVATE ROOM. Patients with insurance should dig into their policy details, says Missy Conley, director of consumer claims for Medliminal, a company that reviews medical bills for errors. Some may require you to have a semi-private room unless there is none available. If you request a private room, you will have to pay for the extra cost.
4. ASK ABOUT YOUR STATUS. If you are covered by Medicare and you stay at the hospital after an emergency department visit, you may be kept for observation or admitted as an inpatient. If you are kept for observation, your out-of-pocket costs may be higher than if you were admitted, says Toby Edelman, a lawyer at the Center for Medicare Advocacy, a nonprofit public interest law firm. And if you are sent to a skilled nursing facility after being kept for observation, you will have to pay for your room and board entirely out of pocket. PARAGRAPH You can ask your hospital physician to admit you as an inpatient. If that doesn't work, ask your primary care physician to speak with your hospital physician on your behalf, says Edelman. For other options, check out the Center's self-help packet on the topic.
5. AVOID UNNEEDED CARE. Some common exams are unnecessary. "Daily blood draws in the hospital are often not needed and should be questioned, unless you are in the intensive care unit," says Robert G. Holloway, MD, MPH, FAAN, professor and chair of the neurology department at the University of Rochester Medical Center in New York. Similarly, neurologic patients often undergo repeated scans like MRIs and CTs. Ask your doctor if the exam is necessary to determine treatment, Dr. Holloway says.
6. HAVE SOMEONE ACCOMPANY YOU. Bring a companion who can keep track of doctors, tests, medications, and procedures so you can compare it against the hospital bill. "In my family, we do not allow anyone to stay in the hospital without having someone with them 24/7," says Beth Morgan, owner of Medical Bill Consultants, LLC, which analyzes bills for errors.
7. BUY YOUR OWN MEDICAL SUPPLIES OR EQUIPMENT. Hospital-supplied walkers, canes, foot braces, and even slings can cost three times as much as they would at a pharmacy or a medical supplies company or online, says Conley. They are covered by Medicare regardless of where they are purchased, but patients must pay 20 percent of the cost, so it makes sense to buy less expensive versions, says Conley. Some medical equipment companies may submit an insurance claim for you; otherwise, you may need to file it yourself. Keep the receipt and the prescription for any items you buy.
8. REVIEW MEDICAL BILLS CAREFULLY. Ask for an itemized bill from the hospital and each doctor who treats you. "The bill should include the items billed, the price adjustments your health plan has negotiated, and all payments the health plan has made," says Conley. Compare those bills with the explanation of benefits from your insurance company. If they don't match, call the physician's office.
   
   Errors are common, Morgan says. She has found charges for services or medications patients didn't receive or for items—like gowns, drapes, surgical instruments, housekeeping, and towels—that are included in the cost of a procedure or hospital room. If you are billed for care you did not receive, take your notes to the hospital billing department to protest the charge. You can also work with billing companies such as Medical Bill Consultants and Medliminal, which receive 25 percent of any savings they find from billing errors.