Hospital treatment costs in Germany work differently from the sticker-price model familiar to many patients in the United States. Germany has a tightly regulated healthcare financing system in which most residents are covered by statutory health insurance, known as Gesetzliche Krankenversicherung (GKV), while a smaller share use private health insurance, or Private Krankenversicherung (PKV). Hospitals generally calculate inpatient treatment using regulated reimbursement rules rather than simply charging an unrestricted daily room rate.
That does not mean every hospital visit is free. Patients may face statutory co-payments, charges for optional services, private-room supplements, separate physician fees, or the full cost of care if they are uninsured or traveling to Germany without appropriate coverage. International patients also need to distinguish emergency or medically necessary treatment during a temporary stay from treatment specifically planned in Germany.
This guide explains how German hospital billing works, what statutory and private insurers normally cover, what self-paying patients should ask before admission, how the DRG system affects bills, and why no single nationwide price can accurately represent the cost of an operation or hospital stay.
How Hospital Care Is Financed in Germany
Germany operates a social health insurance system rather than a single national health service. Most residents have statutory insurance through one of the country’s sickness funds. Eligible higher-income employees, civil servants and certain other groups may choose or qualify for private insurance instead.
The German Federal Ministry of Health oversees the federal healthcare framework, while statutory insurers, hospitals, physicians, states and other institutions each have roles in financing and delivering care.
For an insured patient admitted to a hospital that participates in the appropriate system, the hospital normally settles most covered inpatient charges directly with the insurer. The patient therefore does not usually receive a U.S.-style bill containing the entire economic cost of an ordinary covered hospitalization.
The financial experience can be very different for:
- patients covered by German statutory insurance;
- patients with German private health insurance;
- EU, EEA or Swiss visitors using applicable cross-border healthcare arrangements;
- travelers with private travel insurance;
- international patients who deliberately travel to Germany for treatment; and
- people who must pay the hospital themselves.
Statutory Health Insurance: GKV
Statutory health insurance covers the majority of Germany’s population. It operates according to legislation that defines covered benefits and patients’ cost-sharing obligations.
For medically necessary inpatient treatment at an approved hospital, a GKV patient generally does not negotiate the full hospital price. The hospital bills the sickness fund under the applicable reimbursement system. The patient may still owe the statutory inpatient co-payment and charges for services that are not part of the normal insured benefit package.
The federal health information portal gesund.bund.de provides official English-language information about the German healthcare system and is particularly useful for international residents trying to understand insurance and treatment arrangements.
Private Health Insurance: PKV
Private insurance works differently because coverage is based partly on the individual’s insurance contract. Two people insured by different PKV policies can therefore have different levels of hospital coverage.
A private policy may cover benefits such as treatment by a senior physician, a single or double room, or other elective hospital services, but these benefits cannot be assumed. Deductibles, reimbursement limits and contractual exclusions may apply.
Patients with private insurance should confirm benefits before elective hospitalization rather than assuming that every hospital service marketed as “private” will be reimbursed.
How German Hospitals Calculate Inpatient Treatment Costs
Many acute inpatient hospital cases in Germany are reimbursed through the German Diagnosis Related Groups system, commonly called G-DRG. The system groups cases according to factors such as diagnosis, procedures, complications and other clinical characteristics.
The Institute for the Hospital Remuneration System (InEK) maintains important elements of Germany’s hospital reimbursement framework.
A simplified way to understand DRG-based payment is that a hospital case receives a relative reimbursement weight. That weight interacts with regulated monetary values used within the hospital-payment framework. The resulting amount is not necessarily the same as the patient’s out-of-pocket cost.
Why the Diagnosis Matters
Two patients undergoing procedures that sound similar in everyday language may generate different hospital reimbursement amounts. The final classification can be affected by:
- the principal diagnosis;
- secondary diagnoses;
- the exact procedure performed;
- severity and clinical complexity;
- complications;
- patient characteristics relevant to coding;
- length of hospitalization;
- special medications or implants;
- intensive-care requirements; and
- other separately reimbursable services.
This is one reason a nationwide statement such as “heart surgery costs €X in Germany” can be misleading. Even if a hospital provides a preliminary estimate, the final clinical case may differ from the assumptions used when the quote was prepared.
DRG Payment Is Not the Same as a Cash Price
A DRG reimbursement amount describes part of the hospital-payment mechanism. It should not automatically be interpreted as a public cash price available to every international patient.
Insured patients, privately insured patients and self-paying international patients may be billed through different arrangements. Elective physician services, accommodation upgrades and other supplemental services can also sit outside the standard hospital reimbursement calculation.
How Much Does a Hospital Stay Cost in Germany?
There is no reliable single national figure that answers this question for every patient. The appropriate number depends first on what “cost” means.
| Type of Cost | What It Means | Who Usually Pays |
|---|---|---|
| Hospital reimbursement | Amount calculated under the applicable hospital-payment rules for covered treatment | Usually insurer or responsible payer |
| Statutory patient co-payment | Legally defined contribution for eligible GKV inpatient stays | Patient, unless exempt |
| Optional hospital services | Examples may include upgraded accommodation or elective physician treatment | Patient or private insurer if covered |
| Self-pay treatment estimate | Hospital’s estimate for a person responsible for paying the treatment directly | Patient, sponsor or international insurer |
| Final self-pay bill | Amount due after actual services and clinical course are known | Patient or responsible payer |
Consequently, an insured German resident’s personal expense may be only a small fraction of the amount the hospital receives for the entire case. An uninsured international patient receiving the same complex treatment could be responsible for substantially more.
Treatment Cost Considerations by Service
| Treatment or Service | Cost Considerations | Main Factors Affecting Price |
|---|---|---|
| Emergency department treatment | Depends on examination, tests, treatment and whether admission becomes necessary | Imaging, laboratory testing, procedures, specialist involvement and insurance status |
| Routine inpatient surgery | Generally linked to diagnosis and procedure-based hospital reimbursement rather than a simple nightly rate | Procedure, diagnosis, anesthesia, complexity, complications and length of stay |
| Major cardiac or neurological surgery | Can involve substantially greater resource use; a hospital-specific estimate is needed for self-pay treatment | Operation type, ICU care, implants, clinical complexity and rehabilitation needs |
| Cancer treatment | Cannot be represented accurately by one price because surgery, systemic therapy and radiation may be separate episodes | Cancer type, treatment plan, medication, surgery, imaging and hospitalization |
| Maternity hospital care | Varies according to delivery and clinical circumstances | Mode of delivery, complications, neonatal care and optional accommodation |
| Private room or elective physician services | Often outside standard statutory benefits | Hospital contract, room category, physician arrangements and private insurance benefits |
This table intentionally does not provide invented nationwide euro amounts. For a self-paying patient, a written estimate from the hospital based on medical records is much more useful than an internet average.
Hospital Co-Payments for Statutory Health Insurance Patients
Adult patients covered by German statutory insurance may be responsible for a legally prescribed inpatient hospital co-payment. Under the established statutory framework, the commonly applicable amount has been €10 per calendar day for up to 28 days per calendar year.
Because exemptions and special circumstances can apply, patients should verify their current responsibility with their sickness fund or the official federal health portal before relying on the figure for a specific admission.
Who May Not Have to Pay the Standard Co-Payment?
German cost-sharing rules include protections and exemption mechanisms. Among other factors, age and whether a person has reached an applicable annual co-payment burden limit can matter.
Patients with frequent medical expenses should ask their statutory insurer about the relevant Zuzahlungsbefreiung, or co-payment exemption rules. Eligibility must be determined by the insurer; a hospital website or unofficial calculator should not replace that determination.
What the €10 Co-Payment Does Not Mean
The daily contribution is not the full economic price of inpatient care. It does not mean that surgery, nursing, medications, imaging and specialist treatment collectively cost €10 per day.
It is simply the patient’s statutory contribution when the rule applies. The insured treatment itself is financed separately through the healthcare system.
What Statutory Insurance Normally Covers in a Hospital
For eligible medically necessary inpatient care, statutory insurance generally covers the hospital services required for treatment within the applicable benefit framework.
Covered hospital care may include the medical and nursing services required for the inpatient episode, medically necessary procedures and other components included in the hospital’s reimbursable treatment.
Coverage should not be interpreted as permission to choose every optional service without additional cost.
Standard Care Versus Optional Services
German hospitals may offer Wahlleistungen, or elective additional services. These may include accommodation in a single room or treatment under a particular elective physician arrangement.
A GKV patient requesting such services can become personally responsible for charges that statutory insurance does not cover.
Before signing an elective-services agreement, ask:
- Which service is medically necessary and covered by GKV?
- Which service is optional?
- What is the additional fee?
- Could separate physician charges apply?
- Can the elective service be canceled if treatment plans change?
Private Health Insurance and Hospital Bills
Private health insurance can offer broader hospital benefits, but there is no universal German private policy. Coverage depends on the tariff purchased by the individual.
Some contracts provide extensive inpatient benefits. Others may reimburse only specified categories or apply deductibles and contractual limitations.
Questions to Ask Your Private Insurer
Before a planned admission, obtain answers in writing where possible. Confirm whether the hospital treatment is covered, whether prior approval is required, whether private-room accommodation is included, whether elective physician treatment is reimbursed and whether any deductible applies.
Also ask how the claim will be settled. Depending on the hospital, insurer and treatment arrangement, the patient may receive bills and seek reimbursement rather than having every charge settled directly.
Separate Physician Charges
Patients requesting elective medical treatment by particular physicians may encounter billing separate from the standard hospital component. Germany uses regulated physician fee frameworks in relevant private billing situations.
If a hospital asks you to sign a Wahlleistungsvereinbarung, read the financial terms carefully. Do not assume that a private insurer will reimburse the entire physician fee merely because the insurer covers hospitalization generally.
Hospital Treatment in Germany Without German Health Insurance
Foreign visitors and international patients can receive hospital treatment in Germany, but payment arrangements should be established before planned care whenever possible.
An uninsured patient may be asked for advance payment or a financial guarantee. For expensive treatment, hospitals can request medical documents first so they can determine the expected treatment pathway and prepare an estimate.
What a Self-Pay Estimate May Include
A meaningful estimate should identify the clinical assumptions used to prepare it. Depending on the case, the quoted amount may account for hospital treatment, expected length of stay, procedures and certain related services.
However, patients should specifically determine whether the estimate also includes:
- physician fees;
- anesthesia;
- pathology;
- high-cost implants;
- special medicines;
- intensive-care treatment;
- interpretation or translation services;
- private accommodation;
- post-discharge rehabilitation; and
- follow-up consultations.
Some of those services may be included in the hospital’s expected reimbursement calculation, while others may be billed separately depending on the arrangement. The hospital’s international office or billing department should explain exactly what the quotation covers.
Why the Final Bill May Exceed the Estimate
A hospital estimate is normally based on an expected clinical course. Medicine does not always follow that forecast.
A complication, unexpected diagnosis, additional operation, longer hospitalization, ICU admission or expensive therapy can change the final amount. Conversely, actual treatment may sometimes require fewer resources than anticipated.
Ask the hospital what happens if the final cost differs materially from the advance payment and whether any unused balance is reconciled after discharge.
International Patients Planning Treatment in Germany
Patients traveling specifically for German medical treatment should contact the hospital before booking travel. Large university hospitals and other major medical centers may have an international patient office, although availability and services vary by institution.
The hospital will often need enough medical information to determine whether it can offer the requested care.
Documents Commonly Requested
Exact requirements differ, but international patients may be asked to provide medical reports, diagnostic imaging, pathology findings, current medication information, previous operation reports, passport or identification details, insurance documentation and billing or payment guarantees.
Records may need to be supplied in German or English depending on the hospital.
For complicated treatment, sending complete records can improve the usefulness of the hospital’s preliminary medical review and financial estimate.
Do Not Confuse a Cost Estimate With Acceptance for Treatment
Financial arrangements and medical acceptance are separate issues. Paying a deposit does not guarantee a particular clinical result, and receiving an indicative price does not necessarily mean a specialist has confirmed that the requested intervention is appropriate.
A responsible hospital should evaluate the patient’s medical situation before confirming a complex planned treatment.
EHIC and Temporary Visitors From Europe
Residents insured under an eligible European public healthcare system may be able to use the European Health Insurance Card (EHIC) during temporary stays in another participating country.
The European Commission’s Your Europe guidance on unplanned healthcare during temporary stays explains the basic cross-border framework.
EHIC is designed for medically necessary state-provided healthcare during a temporary stay under the applicable rules. It is not equivalent to comprehensive travel insurance.
EHIC Is Not a General Medical-Tourism Payment Card
A major source of confusion is the distinction between becoming ill while temporarily abroad and traveling abroad because you intend to receive a particular operation or treatment.
Planned cross-border healthcare is governed by different rules and may require authorization from the patient’s home-country institution. In applicable European coordination arrangements, the S2 form can be relevant for planned treatment.
Patients considering treatment in Germany should contact their competent national health institution before traveling rather than assuming an EHIC will pay for the planned procedure.
Travel Insurance Still Matters
EHIC does not necessarily cover every healthcare-related financial risk associated with international travel. Travel insurance may provide benefits outside the public cross-border healthcare framework, depending on the contract.
Travelers should check emergency medical coverage, deductibles, exclusions for pre-existing conditions, repatriation benefits and insurer authorization requirements before departure.
Emergency Hospital Treatment for Visitors
Urgent medical situations should be treated according to their clinical urgency rather than delayed while a patient searches for an exact treatment price. Germany’s emergency number for life-threatening situations is 112.
Financial responsibility still exists, however. Visitors should provide applicable health-insurance or travel-insurance documents as soon as reasonably possible.
If you are insured abroad, contact the insurer’s assistance service after immediate safety needs have been addressed. Many travel insurers have procedures for hospital guarantees, direct billing or claim documentation.
Does Germany Have U.S.-Style Hospital Price Transparency?
The German system should not be evaluated using U.S. hospital pricing terminology. The United States relies heavily on concepts such as negotiated insurer rates, chargemasters, deductibles and federal hospital price-transparency files. Germany uses a different regulatory and reimbursement structure.
For German inpatient care, understanding the diagnosis-based payment framework and insurance status is usually more useful than looking for a universal hospital cash-price list.
A self-paying patient should therefore request a case-specific estimate rather than expecting an online menu showing a guaranteed total for each operation.
How to Obtain a Reliable Hospital Cost Estimate
The best estimate starts with medical information, not merely the name of a procedure. A request stating “How much is cancer treatment?” is unlikely to produce an accurate answer because cancer care can involve radically different combinations of surgery, medicines, radiation, imaging and hospitalization.
Step 1: Identify the Correct Hospital Department
Contact the specialist clinic, admissions team or international patient office relevant to the diagnosis. Sending financial questions to a general reception inbox can delay the process.
Step 2: Provide Complete Medical Records
The treating team may need diagnostic details before the hospital can estimate the expected clinical pathway. Remove ambiguity wherever possible by providing current reports and previous treatment information.
Step 3: Request the Estimate in Writing
Ask the hospital to describe what is included, what is excluded, the assumptions behind the estimate, the required deposit and the procedure for reconciling the final bill.
Step 4: Verify Insurance Separately
A hospital saying it can treat you is not the same as an insurer agreeing to reimburse the treatment. Give the insurer the hospital’s documentation and obtain any required preauthorization before a planned admission.
Step 5: Plan for Non-Medical Expenses
Medical quotations usually should not be assumed to include airfare, accommodation for relatives, local transportation, food outside the hospital, visa expenses or an extended stay in Germany after discharge.
Questions to Ask the Hospital Before Treatment
| Question | Why It Matters |
|---|---|
| Is this estimate for the entire inpatient episode? | Some quotes cover only particular hospital components. |
| Are physician fees included? | Elective or private physician services can be billed separately. |
| What clinical assumptions were used? | A quote based on an uncomplicated stay may change if complications occur. |
| Is an advance deposit required? | International self-pay patients may need to fund treatment before admission. |
| What happens if actual costs are higher or lower? | You need to know how additional payments and refunds are handled. |
| Are follow-up visits included? | Post-discharge care may be a separate treatment episode. |
What Can Make a German Hospital Bill Higher?
The medical complexity of the case is one of the strongest cost drivers. A straightforward operation and an operation followed by intensive care should not be expected to produce the same financial result.
Other potential factors include additional diagnoses, extended hospitalization, high-cost medicines, specialized implants, repeat procedures, dialysis, intensive monitoring and elective amenities.
For international patients, nonclinical services such as translation or administrative support may also have separate financial arrangements.
Rehabilitation and Follow-Up Care After Discharge
The hospital bill is not always the end of the financial pathway. Some patients require rehabilitation, outpatient specialist appointments, physiotherapy, home nursing, medications or additional diagnostic tests after discharge.
Insurance rules for these services can differ from inpatient hospital coverage.
An international patient should ask the medical team how long follow-up is expected to continue in Germany and which elements can safely be transferred to physicians in the patient’s home country. Medical decisions about travel and post-operative follow-up should be made with the treating clinicians.
How to Compare Hospitals Without Focusing Only on Price
Price matters to self-paying patients, but it should not be the only criterion used for a serious medical decision. A low preliminary quote offers limited value if the hospital does not routinely provide the specialist care a patient needs.
Consider the clinical department involved, physician qualifications, availability of relevant multidisciplinary services, diagnostic capability, intensive-care support where appropriate, continuity of follow-up and practical communication arrangements.
For complex conditions, patients can also research Germany’s university hospitals and certified specialty centers relevant to the diagnosis. Certification should be verified through the responsible professional or institutional organization rather than assumed from advertising language.
Common Billing Mistakes International Patients Should Avoid
One mistake is comparing online treatment-package advertisements with an official hospital estimate. A marketing price from an intermediary may not reflect the final hospital charge or the services appropriate to the patient’s diagnosis.
Another is assuming that a private insurer, travel insurer or foreign national healthcare system will reimburse treatment merely because the German hospital is willing to provide it.
Patients should also avoid paying a large amount without understanding the hospital’s written payment conditions. Verify the recipient, official hospital banking details, refund procedure and what happens if treatment is canceled or altered.
Finally, do not assume that “hospital cost” includes every professional service involved in care. Clarify possible separate bills before admission.
Frequently Asked Questions
How much does one day in a German hospital cost?
There is no single nationwide economic cost for one hospital day because German inpatient reimbursement depends mainly on the clinical case rather than a simple universal per-night charge. For many adult statutory-insurance patients, the established patient contribution has been €10 per calendar day for up to 28 days in a calendar year when the statutory rule applies. That co-payment is not the actual cost of the hospital care. A self-paying patient needs a case-specific estimate based on the diagnosis and expected treatment.
Is hospital treatment free in Germany?
Not literally. Germany finances hospital care primarily through health insurance and regulated reimbursement systems. A person with statutory insurance generally has covered medically necessary inpatient treatment paid largely through the insurance system, but co-payments and charges for optional services can apply. Privately insured patients depend on their policy terms. Uninsured or self-paying patients may have to finance the hospital treatment themselves.
How much does surgery cost in Germany without insurance?
No responsible nationwide price can be given without knowing the operation, diagnosis and clinical complexity. German hospital reimbursement may depend on DRG classification, procedures, complications, length of stay and additional services. International self-pay patients should send medical documentation to the hospital and request a written estimate. Ask whether anesthesia, physician charges, implants, ICU care and follow-up are included.
Does German statutory insurance cover hospital surgery?
Medically necessary inpatient surgery is generally covered for eligible statutory-insurance patients when provided within the applicable German healthcare framework. Patient cost sharing may still apply, and elective extras such as upgraded accommodation or certain private physician arrangements are not automatically covered. Coverage for a specific admission should be confirmed with the patient’s sickness fund, particularly when authorization or unusual treatment arrangements are involved.
Can an American receive hospital treatment in Germany?
Yes. German hospitals can treat patients from the United States, although arrangements differ between emergency care and treatment planned in advance. An American patient should determine how payment will be guaranteed because ordinary U.S. health insurance does not automatically imply unrestricted coverage abroad. For elective medical travel, contact the German hospital and the U.S. insurer before departure and obtain written information about coverage, deposits and expected treatment costs.
Can I use my EHIC for hospital treatment in Germany?
An eligible European Health Insurance Card can generally be used for medically necessary public-system healthcare during a temporary stay according to applicable European rules. It should not be treated as blanket authorization for medical tourism. If you are traveling to Germany specifically to receive planned treatment, separate cross-border authorization rules may apply. Contact your national health institution before traveling.
Will EHIC pay for planned surgery in Germany?
Do not assume so. The EHIC framework primarily addresses medically necessary healthcare during a temporary stay. Planned cross-border treatment is governed by separate arrangements, and prior authorization may be required. The S2 route can be relevant in qualifying situations. Patients should obtain approval from the responsible health authority or insurer in their home country before scheduling the German treatment.
Do German hospitals require advance payment from international patients?
They may. For planned self-pay treatment, hospitals can require a deposit or other proof that treatment costs will be covered. The amount and procedure depend on the institution and expected treatment. Ask for official written payment instructions and confirm what happens if actual treatment costs differ from the advance amount. Insurance guarantees may be handled differently from direct self-payment.
Can a German hospital quote change after treatment begins?
Yes. A preliminary estimate is usually based on the expected diagnosis, procedure and hospital stay. If physicians discover another condition, perform an additional procedure, treat a complication or extend the hospitalization, the financial calculation can change. Before admission, ask how the hospital handles cost overruns and whether unused advance payments are refunded after the final account is completed.
Does private health insurance cover a single hospital room in Germany?
Some German private health insurance tariffs include single-room or other upgraded accommodation benefits, but not every policy does. Coverage is determined by the insurance contract. Patients should obtain confirmation from their insurer before accepting optional accommodation, particularly because a general inpatient benefit does not necessarily mean every elective hospital service is fully reimbursed.
Are German hospital prices cheaper than U.S. hospital prices?
Direct comparisons can be misleading because the two countries use very different financing and reimbursement systems. German inpatient treatment is heavily regulated and commonly financed through social or private insurance arrangements, whereas U.S. hospital pricing involves different negotiated rates, benefit structures and patient cost-sharing rules. A person considering treatment abroad should compare actual written estimates, insurance reimbursement and travel-related costs rather than broad country-level price claims.
How can I get the most accurate treatment price before traveling to Germany?
Contact the hospital’s relevant specialist department or international patient office and submit complete medical records. Request a written treatment and cost estimate describing what is included, what may be billed separately, how long the assumed hospital stay is and what deposit is required. Then send the documentation to your insurer or responsible payer and obtain any required authorization before making nonrefundable travel arrangements.
Making a Safe Financial Decision Before German Hospital Treatment
The key to understanding hospital treatment costs in Germany is separating the cost of the clinical case from the amount the individual patient must personally pay. For statutory-insurance patients, most medically necessary inpatient costs are handled between the hospital and the sickness fund, subject to applicable co-payments and coverage rules. Private patients need to examine their individual tariffs, while international self-paying patients should obtain hospital-specific estimates.
Before planned treatment, compare the hospital’s relevant clinical expertise, physician and department credentials, location, expected treatment pathway, insurance authorization and written cost estimate. Ask which services are included, whether professional bills can be separate and how unexpected medical complications would affect the amount due.
For cross-border care, verify coverage with the responsible insurer or national institution before traveling. EHIC rules, planned-treatment authorization, private travel insurance and self-pay arrangements are not interchangeable. A clear written financial plan before admission is far more dependable than an online average treatment price.
Medical and informational disclaimer: This article provides general educational information and is not medical, insurance, financial or legal advice. Hospital reimbursement rules, insurance benefits, co-payments and individual treatment costs can change. Confirm current medical and financial arrangements directly with the hospital, your insurer and the appropriate public authority before treatment.
Sources Used
German Federal Ministry of Health (Bundesministerium für Gesundheit): Official information on Germany’s healthcare and health-insurance framework. https://www.bundesgesundheitsministerium.de/
gesund.bund.de: Federal German health information portal with official patient information, including English-language healthcare guidance. https://gesund.bund.de/en
Institute for the Hospital Remuneration System (InEK): Official institutional information concerning Germany’s G-DRG hospital reimbursement system. https://www.g-drg.de/
European Commission — Your Europe: Official EU guidance concerning medically necessary healthcare during temporary stays and European cross-border healthcare arrangements. https://europa.eu/youreurope/citizens/health/unplanned-healthcare/temporary-stays/index_en.htm
GKV-Spitzenverband: National Association of Statutory Health Insurance Funds and institutional information concerning Germany’s statutory health-insurance system. https://www.gkv-spitzenverband.de/
Federal Ministry of Justice — German Laws: Official source for German federal legislation relevant to statutory health insurance and hospital financing. https://www.gesetze-im-internet.de/
Editorial freshness note: Germany’s basic insurance and hospital-payment framework described above is based on established official institutional guidance. Because live web verification was unavailable while this article was prepared, readers should confirm any current 2026 co-payment amount, reimbursement rule, insurer requirement or hospital-specific policy directly with the relevant German authority, insurer or hospital before making a financial decision.