Why ER Costs too Much Even after Healthcare Insurance

Average ER Costs

You get in an accident suddenly. You are not bleeding, but still, to be on the safe side, you visit an ER to ensure no injuries. ERs are quite expensive. They can cost you a lot even if your condition is not too much serious. Nurses and physicians can easily treat some medical issues at urgent care or a walk-in clinic. But mostly, to make sure there are no serious injuries, people often visit ER for a proper checkup. So, we should know about medical emergencies to avoid visiting emergency rooms after an accident. Only medical emergencies require ER visits. An average ER visit can cost you $500-$2000 (it may increase to $3000 or above). The cost varies since it is based on several factors like the patient’s condition, hospital, supplies, medicines, triage fees, professional fees, specialists fees, tests, etc., during the treatment. However, sometimes the billings are high without any reason. Even if your condition isn’t serious and you haven’t been highly treated, the hospital may charge you a lot.

Why ER Costs too Much Even after Healthcare Insurance

Health insurance plans are quite helpful. These plans are a contract between an Insurer Company and a person. In times of need, they fully or partially pay your medical expenses. However, these plans vary. The amount they will be covering and other details are mentioned in that plan.

Even if a person is insured, they may end up paying costly ER bills. Various factors are contributing to ER bills. In some cases, the intermingling of these factors results in a high bill. These contributing factors are discussed below.

Running ER is expensive

ER serves 24/7. Specialized and skilled staff is available at all times. They provide medical care to the patient, diagnosing and treating severe to very severe injuries and illnesses. The staff try their best to provide the best possible treatment in no time providing medicine, equipment, supplies, food, and sometimes surgeries are also performed. In addition to all these, electricity bills, utility bills, keeping the rooms stocked, and maintaining hygiene are quite expensive for hospitals. So, running an ER is costly. Finally, these expenses are passed on to the bills of patients, and that’s why the charges of an ER are always too much.

 High Demand; High Cost

There is a high demand for emergency rooms. In times of emergencies, people don’t remember about walk-in clinics or urgent care clinics. They rush towards the nearest hospital with an emergency room. People will prefer to visit the one that is one mile away rather than visiting the one that is 10 miles away. In such scenarios, these hospitals will charge you more. The more easily you avail of the benefits, the more expensive it will be. That’s how it works. You will only know about your condition once the bills are in your hands and you are done with the checkups and treatments.

Lack of Transparency

During your visit to ER, you can’t find about the charges of the treatment and services. Doctors and nurses will examine you. A treatment that is best suitable for you will be provided, which is decided by the physician. It may include blood tests, MRI, CT scans, etc. The ones who are treating you are not the ones charging you. Emergency departments are separate entities, but they work under the hospitals to which they are attached. The billings are based on the services that are provided. The charges of services are not like a menu at a restaurant. You won’t have an idea of all the expenses until you are done with your treatment.

 Hidden Charges

There are hidden costs during an ER visit termed as “facility charges.” Whatever facilities you are served with, you will have to pay these hidden charges. Apart from that, it is decided by the hospital, so again you won’t have a clue about your bills. Similarly, severity is another important factor. The charges will increase with the severity of the patient.

 Total Cost is not Covered by Insurance.

Only life-threatening situations are counted as an emergency, not all. Even if your insurance company covers the medical cost, you still need to pay a lot out of pocket. Out-of-network hospitals and out-of-network doctors will add up to your ER bills. Similarly, if you used an ambulance and your company found it unnecessary, you will end up paying for that. The policies and conditions of health insurance plans vary from one company to another. Even if your condition is critical, it will cover the costs up to some extent.

Another point to ponder is that cover does not mean you have to do nothing. Out of pocket costs like copay, coinsurance, and deductibles are totally on you. Each company has a rate known as negotiated rate with a specific hospital or ER. It constitutes the amount that your insurer will be paying to the hospital on behalf of you. Within the negotiated rate, all the out-of-pocket expenses (copay, coinsurance, and deductibles) will be paid by you. In an emergency, paying rate is the same whether you visit an in-network or out-of-network hospital.

No one pays a planned visit to an ER. But it’s a part of life, and things do happen. Whenever you or your family memeber is injured, the priority is treatment. Health insurance is the best way to protect yourself during ER visits in case of emergencies. But the important thing is you must know the terms and policies. Before purchasing a health insurance plan, check out how much you can pay out of pocket. Study your plan thoroughly to know about in-network facilities and where to go in case of an emergency. Apart from this, you must assess the severity of your condition. The alternatives for ER are walk-in clinics and urgent care clinics. Some medical conditions are non-emergency conditions. Treating them at ER will cost you more. So, a better option is urgent care clinic. They will charge you, but they are cost-friendly and provide healthcare quickly since they are not busier and crowded like ER.