Going to the Emergency Room Without Insurance

An ambulance en route to the Emergency Room

Lack of insurance shouldn’t stop you from going to the emergency room if you have a true medical emergency.

While you must be treated regardless of insurance coverage, financial status, citizenship, or otherwise – the cost for your care can add up extremely quickly if you’re not careful.

Even if you’re in a position to be concerned about costs (and if you’re having a heart attack or other major medical emergency its highly likely you won’t be), it’s still extraordinarily difficult to do so. The doctors and nurses who treat you are focused on the best quality treatment and have little knowledge of what a test or procedure might cost (since this is an entirely different department). 

ER costs are rising rapidly (one study found that they increased by 176% over the last decade) and this is unlikely to get better.

We’ll dive into why these costs are increasing and then discuss what you might be able to do about it.

Increasing Costs of Emergency Visits

Every emergency visit is assessed on a scale of 1-5, supposedly corresponding to the severity of the ER visit, with one being the least severe (e.g. an insect bite) and 5 the most severe (e.g. severe burns, chest pains, etc). If you really want to dig into this, the American College of Emergency Physicians has some great guidelines on how these are coded.

As one would expect, the more severe a visit, the more the hospital can bill for the charge. While certain criteria need to be met to code at a given severity level, this criteria is loose enough that it can be easy to game the system – and it looks like that’s what’s currently being done. According to a Healthcare Cost Institute Report while only 17% of hospital visits were coded as level 5 in 2008, that number ballooned to over 27% by 2017.

Charges for other services are then adjusted based on the severity level. This is how you get the $200 ibuprofen and $100 band-aids that are all over the news.

On top of that, hospitals are increasingly marking up their costs across the board. A Johns Hopkins University study found that some hospitals are marking up their prices by over 1,000 percent (and our internal studies found the average hospital markup is over 4x their costs). Of course insurance companies don’t pay these rates (they negotiate their own rates behind closed doors and fight every effort to release those rates), only the uninsured are forced to pay these exorbitant amounts.

Finally – in general, emergency room services are not shoppable. That is, it’s extremely difficult for the consumer to shop around for the best emergency room rate. This is due in large part because when having a medical emergency, one doesn’t have time to call the 6 nearest hospital and find which one has the best rate for a level 5 visit. Hospitals take advantage of this lack of shoppability to jack up emergency room visit prices even further.

So in sum, we have an increase in code severity to charge higher rates, massive overcharging on hospital rates in general, and a lack of shoppability that threatens to make ER overcharging even worse than general hospital overcharging.

What You Can Do About It

If you have a medical emergency – you should go to the ER regardless of whether or not you have insurance. However, if you do end up with a huge bill, there are a few things you can do about it.

The first is to apply for financial aid. Call your local hospital and ask them to send you an application. Additionally, you can look into Medicaid, Chip, and other government programs. Section 3 of our Guide to Negotiating Your Medical Bills has some great links to finding financial aid.

Second, call up the hospital and ask for a rate reduction in exchange for paying upfront. Hospitals recognize that many uninsured do not pay their hospital bills and would rather collect something over nothing. Section 2 of our Guide to Negotiating Your Medical Bills dives more in-depth on how to negotiate with a hospital or other medical provider.

If you need help negotiating – we can help. We run an analysis of your bills to determine hospital costs, medicare pricing, and insurance reimbursement rates and then identify a fair rate for services provided. Our expert negotiators will then get to work securing that rate from the hospital. Contact Us via filling out a form, calling directly, or setting up a free consultation.