Does Health Insurance Cover Emergency Room Visits?
In general, most health insurance plans cover emergency room visits. The key is to check with your own insurance plan to see if it is covered and what exactly the plan entails, as health insurance benefits will vary greatly.
There are a lot of insurance companies and within each company there are many more health insurance plans. Some of those plans cover very few services, while other plans will be more extensive as to what they cover.
What Type of Health Insurance Do You Have?
The type of insurance plan that you have will determine what kind of health services are covered. The best plans are usually group insurance plans, which are available through your employer. Other plans are self-employed, Medicare, and Medicaid.
Group insurance plans are often the best plans in terms of coverage and price. Group insurance allows you to join a benefit plan without having to go through a long application and approval process. You also are not penalized for pre-existing conditions, as you are with private insurance.
Having a group plan allows you more types of coverage for a cheaper price. More than likely, you will have greater coverage for visits to the emergency room than if you had a different type of plan.
If you have private or self-employed health insurance, your insurance premiums will be higher and you will more than likely have worse coverage than with group insurance. Private insurance takes into account pre-existing conditions, which makes it harder to be approved for a plan and will increase your premiums even more. Plus, conditions that are pre-existing are usually not covered under your plan.
The other options for health insurance include Medicare and Medicaid. Both are sponsored by the government and the benefits with each can vary quite a bit, depending on your plan.
Are Emergency Room Visits Expensive?
Visits to the emergency room are usually more expensive than a regular doctor’s visit. Based on the Medical Expenditure Panel Survey, an office visit to a physician costs an average of $199, while an average ER visit is $922.
One reason is because of the convenience. You may have to wait a few weeks to get in with your regular physician but if you go into the ER, you will be able to be seen that same day.
Also, many of the people entering the emergency room are doing so because they have some type of injury or condition that is life threatening. The care and medication involved with keeping them alive adds up a lot more than just taking care of a cold.
The emergency room can be more expensive because you are charged separately by everyone working on you, whether it is the nurse, doctor, or specialty physician. Medication that is administered also often costs more than it would if you were to get it as a prescription from a regular physician.
Because visits to the ER are so expensive, you may want to double check with your health insurance to make sure you have coverage. This is especially true if it is not life-threatening and you can wait until your doctor is available.
How Many Visits Will Health Insurance Cover?
Even if you do have insurance coverage for visits to the emergency room, see if there are limitations. Often you will be limited to a certain number of visits in a year’s time. If you have reached your visit allotment for a certain time period, then you will be 100% responsible for every visit from that point on. This can add up quickly.
What is the Deductible?
Check to see if you have a deductible for an ER visit. It may be a combined deductible with your other health services, it may have its own deductible, or it may not have one at all. This information is crucial for you to know before you make an unnecessary visit.
What Other ER Costs Are Involved?
Some health insurance plans will have coverage for the emergency room but they also have a flat ER fee. This amount is separate from any other services that you will receive on your visit. It also is a required payment, even if you decide not to continue to get care. Once you step foot in the ER door, you are responsible for that amount.
Along with any deductible amount, see if there is a co-pay for ER services or if you are responsible for a certain percentage of the amount charged.
What is you don’t have Health Insurance?
Even if you do not have health insurance, you cannot be denied care in the emergency room. Attendants in the ER are required to give emergency services until you are stable and can be moved to a different facility.
Although the majority of health insurance plans cover emergency room visits, it is your responsibility to do your own research and find out exactly what your plan covers so that you aren’t shocked when you get the bill. Also decide whether it is worth the extra money to get into the ER or if it is better to wait and see your regular physician.