Emergency Room Bills Can Make You Sick All Over Again!
If you do have to make a trip to the ER, make sure you understand your coverage. Navigating the insurance maze can be tricky, so be prepared.
According to Blue Cross Blue Shield, the average emergency room visit costs consumers a whopping $1,233. What’s even more disturbing is that 65 percent of emergency room visits weren’t classified as actual emergencies. But that doesn’t stop hospitals from assessing astronomical fees for your visit, even if there’s no concrete diagnosis.
$1,233 may not seem like a big deal to you. But I should mention that this figure is on the lower end of the spectrum. If you do a little poking around on the web, you’ll find horror stories. There are stories of individuals who got hit with exorbitant ER bills, despite having adequate health insurance. Like the guy from New York who was billed $83,000 for treatment of a severed finger.
I always thought these stories were outrageous. Then I received a medical bill for $1,400 after a visit to the emergency room for a medical condition that was remedied with an inexpensive prescription that costs around six bucks with or without insurance.
And just when I thought things couldn’t get any worse, I was hit with another bill for a little over $1,200 to cover the cost of the physician’s visit, which was an unimpressive three minutes.
Why Does the ER Cost So Much?
In a nutshell, hospitals and insurance companies work out pre-negotiated rates for services and medication. The rates are usually much higher than what you’d pay at an outpatient facility, drugstore, or pharmacy. (That explains the $28 bottle of Ibuprofen I received to ease the pain after giving birth to my first child. I could purchase three or four bottles for that price at a regular pharmacy!)
IF YOU DON’T HAVE INSURANCE, 100 PERCENT OF THE INFLATED BILL IS YOURS TO COVER.
And if you happen to carry a policy, you must meet the deductible before your coverage kicks in.
I had insurance, and the deductible was met. But my portion of co-insurance was 20 percent. So you can just imagine what the bill would’ve been if I didn’t have health insurance.
Tips that Could Save You a Fortune
The next time you have to visit the emergency room – which hopefully isn’t anytime in the near future – you should consider taking certain actions to avoid sticker shock.
Before the Visit:
- Prepare yourself. Of course, that’s if time permits. If it’s a life-threatening emergency, drop everything and go. Otherwise, gather any information that’s relevant to your medical history or current condition, including prescriptions and medical records. That way, you’ll be one step ahead of the physician when they start asking a ton of questions about your medical history. Plus, you could possibly avoid duplicate treatment if you already have a prescription on hand or if you’ve recently had a series of testing done for the same issues.
- Understand your policy provisions. Have you met your deductible? Is there a co-insurance clause in your policy? Are you required to visit an in-network hospital for the provider to cover the costs? These are all key factors that could possibly save you a ton of money and headaches later on.
During the Visit:
- Be attentive. Even if you’re in pain, pay attention to everything the medical practitioner says. Also, inquire about any treatments that you’re unsure of or that you might deem unnecessary. Remember, it’s your body, and you have the right to refuse treatment.
- Document everything. Each time blood is drawn, you’re rolled away for an x-ray, medication is administered, or any action is taken on your behalf, jot it down. This will make it much easier to dispute erroneous or duplicate line items, should they appear on your bill.
- Retrieve an itemized bill. Before you leave the premises, request an itemized copy of your bill and compare the contents to your notes once you are feeling better. (Quick note: it’s not uncommon to receive separate bills from the facility and the physician’s group. The doctor bill may not be ready for retrieval at the time of your visit, but you should follow up a few days after your release).
After the Visit:
- Request a formal review of your bill. If you spot inaccuracies, don’t hand over any cash until your bill has been audited by the hospital’s business office and a licensed physician (if necessary).
- Contact your insurance provider. In my case, the insurance provider didn’t comply with the terms and conditions of the policy, so I filed a formal appeal. You also have that right if you feel you were assessed a higher amount than what the policy states.
- As I mentioned earlier, the cost of services and treatment rendered in the ER are inflated, so you can contact the billing department to negotiate a lower, more affordable rate. It also helps to have a written request with your justification, such as a lack of insurance or financial hardship. (Another note: the hospital may require detailed financial information to determine the best course of action).
- Make payment arrangements. Most hospitals will work with you before they throw in the towel and send the bill to collection, so you should contact them promptly to set up a payment plan.
Should You Even Go to the ER?
Since I’m not a licensed medical practitioner, I’m not at liberty to advise you on that question. However, I strongly suggest that you go to your wellness visits and have the routine blood tests and physical exams done. That way, you can get a handle on any serious medical issues and obtain the necessary prescriptions and treatment before the condition gets out of hand.
But if a medical emergency does arise and your primary care provider isn’t available, consider urgent care, as the costs will probably be substantially lower than what you’d pay for an emergency room visit. Blue Cross Blue Shield estimates the average urgent care visit to come in at around $60 for their policyholders. For my plan, it’s $50. Plus, the wait times are shorter.
If your primary care provider or local urgent care facility aren’t an option and your health is on the line, it’s better to be safe than sorry.
SIMPLY PUT, MEDICAL BILLS ARE NEGOTIABLE – YOUR HEALTH IS NOT.
A Final Thought
In retrospect, I don’t regret my decision to visit the emergency room, but I should’ve been more attentive to the policy provisions and the treatment rendered since most of the procedures were unnecessary. The good news is that my health has improved dramatically, and I’ve successfully negotiated the sky-high medical bills. Most importantly, I’ve finally learned what it takes to navigate the ER maze without spending a fortune.