Headed for the hospital soon? Worried that your insurer's stingy cost-sharing formula will leave you with a bill more painful than your surgical scars? Worse yet, worried that a lack of coverage will bankrupt you? Maybe it's time to shop around.

"More and more people are getting a percentage of [hospital fees] charged against them," said Gary Vogan, a senior vice president at Holy Cross Hospital in Silver Spring. In general, he said, people who are concerned about price "are better off coming into Maryland rather than staying in Virginia or D.C."

According to the nonprofit Institute for Health and Socio-Economic Policy, which last month issued its second annual report on hospital charges, hospitals nationwide typically charge 132 percent more for their services than they actually cost. The Virginia hospitals in the report had an average markup of 137 percent, while District hospitals added 115 percent. Maryland's markup was just 20 percent, the lowest of any state.

Bills for cesarean sections at Holy Cross averaged $4,785 last year, according to Vogan, who said most patients could expect their bill to be up to 20 percent higher or lower than the average. The comparable number reported by Montgomery General Hospital was $5,050. Vaginal deliveries at Holy Cross averaged $3,512 last year, and the typical newborn's two-day stay produced a bill of $1,083.

For the 146 hip replacements done at Holy Cross last year, the average charge, including a three-day stay at the hospital, was $12,723.

Several hospital spokesmen cautioned that such fees are only part of a procedure's overall expense. For example, Vogan said, a surgeon or anesthesiologist would issue a bill separate from the one sent by Holy Cross. (Vogan added in an e-mail that his hospital also offers substantial discounts to needy patients.)

"A self-pay patient will want to know everything, because they're going to pay for it," said Lester Asher, the admissions manager at Suburban Hospital in Bethesda, where the typical hip replacement requires a four-day stay and generates a bill of $14,800.

By comparison, Virginia Hospital Center in Arlington and Inova Fairfax Hospital charge self-pay patients more than $17,000 for hip replacement, on average.

It's important to note that people with insurance often benefit from big discounts their plans have negotiated with hospitals in Virginia and the District. Maryland hospitals are not permitted to offer such discounts.

As a result, according to a statement from Irvin W. Kues, chairman of the state's hospital cost review commission, "self-pay patients in Maryland are treated much more fairly here than in hospitals nationally."

Best advice: If you'll be paying for some or all of a hospital stay, it may be smart to check out your options.

-- Tom Graham

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