When you or a loved one is very sick, in a lot of pain, or needs immediate medical attention, chances are your first impulse is to visit an emergency room(er).
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In this article, I’ll explain when to visit the ER, what the average cost of an ER visit is in each state, and what factors influence the prices of an ER visit.
then I will suggest alternatives to an emergency room visit for your urgent health care needs.
Finally, I’ll tell you how to determine if your bill is correct and what you can do to make the cost of an ER visit less overwhelming.
when to visit the emergency room
The leading reason for emergency room visits in 2018 was injuries and poisonings, resulting in 10 million hospital admissions out of 20 million visits.
Abdominal pain, acute upper respiratory infection, and chest pain were next in frequency of emergency room visits.
While chest pains might be considered an emergency, the other symptoms most likely can be treated at an urgent care center or by a primary care physician (PCP).
If your condition is life-threatening or causes you extreme pain, it warrants a visit to the emergency room.
If you have a sprained ankle but can still walk with some support, urgent care is probably your best option in terms of time and cost.
Understanding the difference between significant discomfort and serious injury will make it easier to decide where to seek help.
the cost of an emergency room visit
The average cost of different types of illnesses treated in an emergency room varies depending on what is involved in managing the condition and whether tests are needed.
average cost of emergency room visits
In 2019, the average cost of an emergency room visit for an insured patient was $1,082.
Those without insurance spent an average of $1,220.
Average costs may vary by state and disease, but range from $623 to $3,087.
why a visit to the emergency room is so expensive
Emergency rooms are very expensive operations to manage for several reasons.
for an emergency room to be ready to treat patients with acute medical problems, it is necessary to have a lot of expensive equipment, which requires frequent maintenance to ensure operability, medical supplies, medications and items such as gowns, bed. , beds and monitors.
Secondly, since emergency rooms operate on a 24-hour schedule, they require a lot of staff to keep them in tip-top condition.
That staff includes everyone from maintenance staff to trauma surgeons.
All of these costs are passed on to insurance companies and to patients who visit the ER.
how costs are determined
In addition to direct care costs, when you check in as an emergency room patient, you are also charged a facility or triage fee.
Beyond that, costs are determined by the hospital, which can vary greatly from place to place.
some of the cost factors include:
- supplies used
- drugs administered
- number of doctors, nurses and ancillary staff caring for you
- tests required
- equipment used
Check with your insurance to see if you have emergency room coverage.
Even if you have this coverage, you may still have a large bill, which may depend on whether you are seen at an in-network facility and how your insurance plan is structured.
This situation arises in part due to balance billing.
Insurance companies negotiate rates with hospitals as they do with all doctors.
As a result, your insurance may not have a good rate with a hospital you visit, which could affect your bill.
You’ll also need to meet your deductible before your insurance will cover your visit, so if you have a $2,500 deductible, you’ll have to pay it before the rest of your ER bill is covered.
alternatives to er
The emergency room is not your only option when it comes to medical care. consider these alternatives (unless you are facing a medical emergency that requires you to call 911):
primary care provider
Your PCP is the best person to see you for all of your health problems that are not life-threatening.
Some pcps may have busy schedules that will require you to wait a few days before seeing them for acute care, but most will be able to prescribe medication or send you to the local urgent care for immediate help.
also, some pcps have a physician assistant (pa) or nurse practitioner (np) that you can see right away.
Many also have after-hours advice lines that are staffed by ancillary providers or by the provider themselves, to help you decide what care you need.
Scheduling regular yearly checkups with your PCP will help maintain your overall health.
Your PCP can give you care or help you find the right care for any of your health problems.
Urgent care can be a good option for uncomfortable conditions that are not life-threatening.
If you live in or near a suburban or urban area, you should be able to find an urgent care center that is open after hours and on weekends.
These are some medical problems that can likely be treated at an urgent care center and will help you avoid the expense of visiting an emergency room:
- bladder infection
- body aches
- ear infection
- excessive vomiting or diarrhea
- minor burns
- severe sore throat
See also : Find an In-Network Dentist – Humana
Telemedicine continues to increase in availability and ease of use.
is a great way to see a doctor for less serious problems, such as acne, birth control, urinary tract infections in younger people (older people should be seen in person by a doctor for these problems), and others minor problems.
Also, the cost of telemedicine can be much less than urgent care or a PCP visit.
If you don’t have insurance, are concerned about the cost of meeting your deductible, or have high copays, a free clinic may be an option that works for you and your family.
You can find a free clinic in your community by contacting the National Association of Charitable Free Clinics.
dispute a surprise medical bill
If you’re faced with a surprise medical bill, there are ways to dispute it.
identify the codes
As mentioned above, an important factor in the cost of an emergency room visit is the level of care required. so when you get your bill, check to see how your visit was coded.
This will indicate the complexity of decision making that was required in your care. .
codes for emergency visits are below:
- 99281-direct (level one)
- 99282-low (level two)
- 99283-moderate (level three)
- 99284- moderate to high (level four)
- 99285-high (level five)
know your rights
The No Surprises Act of 2022 protects members from receiving surprise medical bills when receiving most emergency services.
In addition, the no surprises law guarantees a dispute resolution process for those who dispute their bill, whether they are insured or not.
If you think your medical bill is more than you should pay, there are several things you can do to help lower this cost.
You can negotiate with your insurance company if you are an out-of-network provider, ask the hospital to adjust your bill based on your age or income, or request a discount by paying the entire bill all at once .
Keep trying and ask to speak to management if you don’t get the answer you want from customer service, either at the insurance company or at the hospital.
It never hurts to ask.
Many hospitals can also set up payment plans if the entire bill is too high to pay all at once.
Some hospitals also have financial assistance programs to help with bills if you qualify based on their inclusion criteria, which will typically require a more detailed review of your finances.
how health can help
Did you know you can get affordable primary care with the k health app for non-life threatening situations?
Download k health to check your symptoms, explore conditions and treatments, and if needed, text a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.