A trip to the ER could save your life….but it could throw your financial health into cardiac arrest. To help you avoid a tsunami of medical bills after being treated in an emergency room, here are 3 tips to consider:

1.Think twice before heading to the ER

ERs are meant for life-threatening illnesses. They are staffed by specially trained medical professionals who are armed to provide highly critical care both in diagnosis as well as treatment of emergent health situations. When you step foot into an ER, you will receive a lot of care and testing as a normal course of events. This care translates into significant costs, costs that routinely are higher specifically because the services were provided in an ER rather than in another type of medical facility, like an Urgent Care Center or doctor’s office. Depending on a number of factors, you could be responsible to pay the costs of that care. If you are having a heart attack, you should without question, immediately head to the closest ER. But if you feel as if you are coming down with the flu, or you sprain your wrist, you might be better served financially to seek care for these conditions outside of the hospital ER, without compromising the quality of your clinical care.

2.The ER is in your network….but are the ER staff?

Most people don’t realize that many hospital departments are staffed through contracts with outside providers. ERs often fit this model. While there are no apparent signs that a doctor treating you in the ER is not a member of the staff of that hospital, in actuality they could be employees of a corporation of ER physicians who act as the in-house staff for the ER. Why is that important to know? Because the ER physician who is assigned to handle your care might not participate in your health insurance network, even if the hospital that he/she works in does participate in your plan. This means that your care by an out-of-network doctor could result in higher deductibles, copays, and coinsurances, all costs that you would bare. In the worst situation, that care might be fully denied by your insurer if your policy doesn’t provide any out-of-network coverage.

3.Ambulance transport to an ER might not be covered by insurance

Insurance coverage for ambulance transport varies widely. It is not unusual for an insurer to deny coverage for the ambulance if the patient was not admitted to the hospital as a result of the ER visit. Additionally, many ambulance companies do not participate in insurance networks. This underscores Point 1….you want to reserve a trip to the ER, whether via your car or an ambulance, for highly critical, life-threatening health needs.

With the expansion of Urgent Care Centers across the country, consumers now have access to highly trained medical care outside of the hospital. These centers can be closer to home, friendlier, and provide faster care than a hospital ER. Since you never know when an emergency might arise, we recommend that you research Urgent Care facilities near your home and office and speak with your insurance company to see which ones participate in your plan. It would be a good time to review the costs for a visit to such a facility so that you can be prepared for the financial consequences in advance of that care.

Should you encounter problems confirming such coverage, or if you are the victim of significant or questionable medical bills because of a recent trip to the ER, reach out to a medical claims advocate to help you sort through the paperwork. Such a patient advocate can go to bat for you to provide medial bill review and help with medical bill disputes.


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