The thought of an ER visit can be scary, not only because you need emergency health care, but out of a sense of worry that you'll be charged too much for services. Health care costs for ER services seem to be rising each year.
Findings from researchers at John Hopkins Bloomberg School of Public Health and Washington and Lee University suggest that these charges can exceed approved Medicare rates for the same services by as much as 10 times. That's a 1,000% markup.
Average ER Costs
The average cost of an ER visit can be as much as a mortgage payment. Hospitals know that our first priority is receiving care right. There's little to stop them from charging steep prices for the care they provide. Rates can be even higher for minorities and patients who don't have health insurance.
The John Hopkins study reported that hospitals in the Southeast were the greatest culprits in charging too much for ER services.
The average cost for an ER visit will vary based on whether you have insurance. A co-pay for an insured person is around $250. This may or may not be waived if you're admitted to the hospital. Even insured patients may have to foot the whole bill if they haven't met the plan's annual deductible.
An ER visit can cost several thousand dollars if you don't have health insurance. It can depend on the level of care you need.
Health plans must meet the IRS 2021 minimums of $1,400 for a single person, or $2,800 for a family, to be considered a high deductible health plan. It could be even higher depending on your plan.
Charges could run into the tens of thousands of dollars in extreme cases when critical care is needed. Ambulance fees can be more than $1,000. Charges for air ambulances can be even worse. It's hard to know what kind of bill you can expect when you're going to an ER for treatment.
ER Visits and Your Insurance
You might receive a very high bill if you're away from home when you need care, or if you must visit an out-of-network provider for any reason. Seven out of 10 patients didn't know they were using an out-of-network healthcare provider at the time they sought care, according to a Kaiser Family Foundation report.
Some insurers are putting ER charges under the microscope to determine whether the visit was for a true emergency. some are refusing to pay full charges for visits if they decide that the hospital is charging too much. This can leave a patient with an unpaid bill for ER charges that aren't covered by the insurer.
Anthem Blue Cross Blue Shield of Georgia was sued by the American College of Emergency Physicians and the Medical Association of Georgia in 2018 for refusing to pay for ER visits that were deemed not to have been emergencies.
Affordable Care Act Changes
Your health insurance company will require a co-pay for ER treatment if you're insured. It will vary based on your health insurance plan.
Under the Affordable Care Act (ACA) Patient’s Bill of Rights, insurers haven't been allowed to charge higher co-pays for out-of-network hospitals since Sept. 23, 2010. Patients aren't required to get preapproval for ER care. But plans that are grandfathered in before this date are exempt from this rule.
What Does the Future Hold?
Don’t look for ER charges to go down in the near future. A New York Times report cites Yale University research that shows that many hospitals are outsourcing ER care to out-of-network providers that are aggressively overpricing services. Always go to the nearest ER if you have a choice.
A tool from Medicare.gov will provide you with a list of the nearest hospitals in your zip code, city, or state.
You Have Options
You may have some options for lower ER charges. They include coverage through your state if your family is low-income and if yours is one of the Medicaid expansion states that receives ACA subsidies. Go to the HealthCare.gov website to find out if you qualify for Medicaid in your state based on your income.
Some hospitals also offer assistance programs. Charges are limited under these programs, usually to the Medicare allowance for specific services. The ACA limits ER charges for those who are eligible for financial assistance. This provision is only for non-profit hospitals.
Ask to speak with a financial counselor at the hospital. Review all your options if you're not sure about the coverage that's available to you for ER treatment. Some hospitals may even reduce the charges if you dispute them. At the very least, they may offer you a payment plan based on a lesser charge.
It doesn’t hurt for low-income patients to ask to be billed based on a Medicare or Medicaid rate for services. Some hospitals offer to discount ER services by as much as 50% for self-pay or uninsured patients.