Average Cost of an ER Visit and Your Health Insurance

An ER visit can be frightening, not only because you require emergency medical care but also because you are concerned that you will be overcharged for services. The cost of emergency room services appears to be increasing year after year. When it comes to practice operations, billing, coding, staffing, efficiency, and cash flow, emergency medicine is a specialty that presents its own set of issues. As patients are hospitalized swiftly with no insurance information or incorrect insurance information, emergency room billing difficulties are numerous and complex.

According to findings from researchers at Johns Hopkins Bloomberg School of Public Health and Washington and Lee University, these costs can be up to ten times more than approved Medicare prices for the same services. That’s a 1,000% increase.

Emergency Departments

According to the Centers for Disease Control and Prevention (CDC), Americans visited one of the country’s roughly 5,000 emergency rooms 145 million times in 2016. About 23 million of them arrived via ambulance. About 43% of all hospital admissions begin in an emergency room.

Typically, emergency room patients are assigned to one of five levels of care. Level 1 is for mild issues such as earaches. Level 2 may be for a cut that requires stitches, but level 5 may be for more serious issues, such as a shattered bone. Even greater levels of treatment are available for seriously ill individuals. The fundamental reason for the high number of non-urgent ER visits is that hospital ERs are mandated by federal law to offer care to all patients, regardless of their capacity to pay. Patients without insurance or the requisite cash to pay out-of-pocket fees sometimes use emergency departments as their primary health care provider since they cannot be turned away. That places a significant load on emergency rooms and hinders their ability to respond rapidly to medical emergencies. It is projected that more than $18 billion might be saved annually if people with “avoidable” or “non-urgent” medical problems used primary or preventive health care rather than relying on ERs for their medical requirements.

Average ER Cost

An ER visit can cost as much as a monthly payment on average. Hospitals understand that receiving proper care is our priority. There’s little to stop them from charging exorbitant fees for the services they deliver. Minorities and those without health insurance may face substantially higher rates. The hospital ER billing and payment process can be difficult and confusing. When you register, the hospital’s policy is to collect all known fees, including deductibles, co-payments, and co-insurance.

According to the John Hopkins study, hospitals in the Southeast were the worst offenders when charging too much for ER services. The typical cost of an ER visit varies depending on whether you have insurance. A co-pay for a person who is insured is usually around $250. If you’re admitted to the hospital, this may or may not be ignored. If an insured patient has not met the plan’s annual deductible, they may have to pay the entire bill.

If you don’t have health insurance, an ER visit can cost you thousands of dollars. It may be determined by the level of care that you require. To be classified as a high deductible health plan, health plans must meet the IRS 2021 minimums of $1,400 for a single person and $2,800 for a family. Depending on your plan, it may be even higher.

In extreme cases where critical care is required, charges could amount to tens of thousands of dollars. The cost of an ambulance ride can exceed $1,000. Air ambulance fees can be much more exorbitant. When you go to the ER for treatment, it’s difficult to tell what kind of bill you’ll get.

Emergency Room Visits and Your Insurance

If you need care while away from home, or if you must visit an out-of-network provider for whatever reason, you could face a huge fee. According to a Kaiser Family Foundation survey, seven out of ten patients were unaware they were using an out-of-network healthcare provider when they sought care.

Some insurers are reviewing ER expenditures to determine whether the visit was truly necessary. Some people refuse to pay full charges for hospital appointments if they believe the hospital is charging too much. That can result in a patient being left with an unpaid payment for ER expenditures that aren’t covered by their insurance.

Changes to the Affordable Care Act

If you have health insurance, you will be required to pay a co-pay for ER care. It will differ depending on your health insurance coverage. Insurers have been prohibited from charging higher co-pays for out-of-network hospitals under the Affordable Care Act (ACA) Patient’s Bill of Rights. Patients are not required to obtain preapproval for emergency care. Plans that were grandfathered in before this date, however, are immune from this restriction.

What’s holding of the future?

Don’t look for ER charges that will fall in the immediate future. An article in the New York Times mentions a study by Yale University, showing that certain hospitals give out-of-network service providers aggressive overpricing. If you have an option, always go to the nearest ER.

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Written by: Kaynat Ishfaq
Author has been writing from last 4 years in Healthcare and medical billing field.

 

Tags:

cost of an ER visit, medical billing, medical billing and coding, revenue cycle management, accounts receivable recovery, free-standing er billing, free-standing emergency room, out of network negotiations, prior authorizations

 

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