Patient sitting on hospital bed waiting for surgery looking out window. Photo by Portra Images/via Getty Images

Column: 5 questions to ask during your hospital stay

Editor’s Note: A trip to the hospital can be devastating on a family’s finances. With 46 percent of Americans unable to cover a $400 emergency expense and the average hospital stay costing $4,300 a day (according to 2013 numbers), it’s no wonder that medical bills are the leading cause of personal bankruptcy and has been for years.

Below, reporter and former practicing physician Elisabeth Rosenthal has five questions you should ask during your hospital stay to make sure you get the right care and soften the blow of the medical bills you’re likely to face. It’s from Rosenthal’s new book, “An American Sickness: How Healthcare became Big Business and How You Can Take it Back.”

You can protect your financial health while in the hospital by asking the right questions. Unless you are on Medicare or are a member of an HMO, your stay is (for now) most likely being billed intervention by intervention, visit by visit, item by item. Take these precautions:

"An American Sickness" by Elisabeth Rosenthal

“An American Sickness” by Elisabeth Rosenthal

1. Hospitals have built a huge oversupply of private rooms, though insurers frequently won’t cover their cost.

If you are assigned to a private room, make it clear that you did not request it and would be happy to occupy a room with another patient. Otherwise, you might be hit up to pay the “private room supplement” by your insurer.

2. In the pages of admitting documents you’ll have to sign, there is inevitably one concerning your willingness to accept financial responsibility for charges not covered by your insurer.

Before you sign, write in “as long as the providers are in my insurance network.” You don’t mind pay­ing the required co-payments or deductibles, but not out-of-network charges. For every medi­cal encounter, Olga Baker, the San Diego lawyer, adds a “limited consent” clause to the chart, indicating that “consent is limited to in-network care only and excludes out-of-network care.” It has worked well for her, and at the very least, this annotation will give you a basis for arguing later.

3. Be clear on the terms of your stay in the hospital: Are you being admitted or held on “ob­servation status”?

Ask point-blank. The answer will have big implications for your wallet. Hospitals can keep you for up to three days (two midnights) on observation status. Though you will be in a hospital bed, you will be considered an outpatient and be responsible for outpatient co-payments and deductibles, which are generally far higher than those for an inpatient stay. If you are on Medicare, the government insurer will not count days on observation status toward its required three days of hos­pitalization required for coverage of a stay in a rehabilitation center or nursing home after discharge. Ask why you cannot be fully admitted. If there’s not a good answer, insist on going the inpatient route.

4. If you’re feeling well enough, ask to know the identity of every unfamiliar person who ap­pears at your bedside, what he or she is doing and who sent him or her.

If you’re too ill, ask a companion to serve as gatekeeper and guard. Write it all down. Beware the nice doctor who stands at the foot of your bed each day and asks if everything’s going OK. That pleasantry may constitute a $700 consultation. There’s an epidemic of drive-by doctoring on helpless inpatients. These medical person­nel turn up whether you need or want them, with the intent of charging for their services. Remember that you can say no. Everything done to you or for you in the hospital will be billed at exorbitant rates.

5. If the hospital tries to send you home with equipment you don’t need, refuse it, even if it’s “covered by your insurance.”

This is a particular concern if you’ve had an orthopedic procedure. Avoid $300 bills for slings you could buy for $10 at a pharmacy, $1,000 knee braces, and $2,500 wheelchairs, all billed to insurance and cluttering up your front closet.

For more on the topic, watch economics correspondent Paul Solman’s full interview with Rosenthal.