How do emergency room visits lead to extreme medical bills?
Medical emergencies present a scenario in which patients are likely to be treated while uninsured or otherwise under-covered. Emergency rooms (ER) are required to treat patients regardless of coverage status. And patients experiencing a medical emergency typically have little choice but to go to the closest emergency room.
Patients without insurance are likely to be left with very high ER bills for which they are 100% responsible. Despite recent protections, some insured emergency room patients with grandfathered plans could still face high ER bills if the emergency room is considered out-of-network.
Understand how emergency room bills really work.
Emergency room visits are assessed on a scale of 1-5, depending on the severity of the visit. More severe visits are charged a higher rate. Uninsured emergency room patients are treated without any potential to consider costs or shop for lower costs. As a result, they are charged full hospital markups.
On January 1, 2022, the federal “No Surprises Act” went into effect, banning insurance companies from denying emergency room claims due to being out-of-network. So most ER bills should be covered now, if it was a true emergency and you had an active policy. You will still have to pay for any co-pays associated with your plan, which are usually a little bit higher than your normal doctor visit. Check your plan’s explanation of benefits to verify your specific coverage.
How to handle bills related to emergency room visits.
If you have high emergency room bills either due to lack of emergency room insurance or insurance claim denial, you have three paths:
- Apply for financial aid. Call the hospital and ask for a financial aid application. Also look into government aid programs.
- Request a rate reduction in exchange for paying upfront.
- Hire a professional negotiating service.