More and more people are becoming the victims of excessive emergency room bills…often to the tune of tens of thousands of dollars. Most people are unaware that an ER visit often will include separate fees from the hospital and the doctors who care for the patients while they are in the ER. Aside from the ER doctor, radiologists, pathologists and others who never meet the patient face to face but who care for the patient also will bill for their services. And to make matters worse, many times those doctors are out-of-network even when the hospital is in network. Additionally, if the hospital is a trauma center, it can charge fees above the standard facility and provider fees to help underwrite the costs they incur for staffing a trauma center.
Sounds complicated? It is. And complication often translates into expense for the unsuspecting patient.
Recently, we worked on a case of excessive billing from Zuckerberg San Francisco General Hospital (ZSFGH), a level one trauma center. The details of this case were showcased in an article by Sarah Kliff from Vox Media and Jenny Gold from Kaiser Health News. As a result of our work and the visibility created by Sarah’s article, we were able to have the excessive $15,666 fee written off.
Among the thousands of ER bills that Sarah has reviewed as a part of her year-long effort to uncover inequities in ER billing, a number have concerned ZSFGH. In her January 7 article, she highlighted a few more cases, one for which Sarah requested our review and opinion. Robert Berman is quoted in this article.
To help protect yourself from incurring unexpected ER bills, do the following:
- If you require emergency services that aren’t life-threatening, visit an in-network Urgent Care center first. In advance of an emergency, locate Urgent Care centers near your home and office and confirm with your health insurance company which ones are in network. This way if an emergency does occur, you will know exactly where to go for care.
- If you must seek care at an ER, use one that is in network. As with Urgent Care centers, research the network status now before you are in need.
- Ambulance transportation is often out-of-network or only covered if you are admitted to the hospital. If you can avoid using an ambulance to reach the ER, you could save yourself from a large ambulance bill (as well as a trauma activation fee if you call 911 and are transported to a trauma center). However if you are in a life-threatening situation, get to the hospital as quickly as possible using the best means of transportation, which could be an ambulance.
- Once you receive the bills for your care, be sure to request detailed itemized bills from the facility and all providers. Review every line item, compare it to the explanation of benefits from your insurance company and if you have any questions, you must address them immediately with the billing department. Errors are common. You want to be sure you pay for an accurate bill.
- If you find the process too complicated or overwhelming, contact a medical claims advocate for assistance.