How to Avoid the High Emergency Room Cost

A trip to the emergency room can be extremely expensive, even for people with robust health insurance plans. However, in many cases, a little planning ahead can help you reduce or avoid the emergency room cost.

Get to Know Your Insurance Policy

The terms of your insurance policy will have the biggest impact on the amount you pay for emergency medical care. It's a good idea to call your health insurance provider to get a better understanding of your copay (how much you owe at the time of the hospital visit) and the percentage of the total bill you would likely be responsible for after you return home. You can also take the opportunity to inquire about the terms of ambulance coverage, which hospitals are in your network, and whether their doctors are included in your preferred provider network. It's important to remember that even if a hospital is in your preferred provider network, the doctors might not be. Often, the doctors are under separate contracts.

The Emergency Room vs. Urgent Care

The emergency room is designed to handle a wide range of complex health conditions and is significantly more expensive than urgent care. Patients are triaged upon arrival in the emergency department and seen in order of the gravity of their situation. A person having a heart attack will be seen before a person with a sprained ankle, for instance. If the emergency room is busy, it can be a very long wait to see a physician for a condition that is not life threatening.

Urgent care, on the other hand, handles health care issues that need immediate care but are not life-threatening, such as a fractured limb or bronchitis. The medical cases they can handle are less complex than what can be done in the emergency room. They can't rush you in to surgery and operate in an urgent care facility. However, this allows them to provide appropriate care to simpler urgent cases at a fraction of the cost and in much less time.

Planning Ahead

It's a good idea to make a note of the information you learned about your insurance coverage and your preferred provider network, as well as a list of hospitals and ambulance companies that are covered under your insurance. Be sure to include the rules around coverage of ambulance rides. You can also make a separate list of urgent care centers that are in your network, and note their location and hours of operation. Keeping this information accessible in your phone or wallet will help you face urgent situations with greater peace of mind.

What to Do if You Get Hurt or Sick

Figuring out whether you should go to urgent care or the emergency department is an important decision. Life-threatening emergencies require immediate care in the emergency room. In that situation, always call 911.

Medically necessary ambulance rides are usually covered by insurance, but if you're able to get around on your own, it may not be covered. Generally, the ambulance service will not charge you for the visit to check on you when you call 911; the charges start when they transport you. If you have a friend or family member drive you to the hospital rather than riding in the ambulance, it could save you the cost of transportation. If your condition is life-threatening, such as a stroke or heart attack, take the ambulance.

You can ask for an in-network physician when you get to the emergency room. However, if an in-network physician is not available, you will need to let another physician provide care.

Illnesses and injuries such as ear infections or a cut requiring a few stitches can be handled at an urgent care facility in less time and at a much lower cost to you. Check your notes to see if your urgent care center is open. Most are open until later in the day and many are open 24 hours a day. If it's open, and your care needs are not life-threatening, urgent care may be the best choice for you. If the urgent care clinic is not open, then you need to decide whether you can wait until it opens or if you are willing to pay the higher emergency room cost. The most important thing is that you get the appropriate care. Hopefully, you can also save some money in the process.