Complete Guide to Dealing with Emergency Room Bills

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Complete Guide to Dealing with Emergency Room
Bills
In an emergency situation, the last thing you
need is an expensive bill for the care you
received. But why are emergency room costs so
high, and how can you lower an ER bill? Check out
this complete guide to dealing with emergency
room bills. How Much Does an Emergency Room
Visit Cost Out-of-Pocket? Emergency room visits
can be expensive, so if you end up in the ER but
dont have health insurance or your coverage is
disrupted for some reason, youll likely owe a
large out-of- pocket sum. The full cost of an ER
visit depends on the services you receive there.
While figures vary, United Healthcare estimates
that the average amount an individual will spend
on an ER bill is 2,200. Meanwhile, the Consumer
Health Ratings figured that average emergency
room costs for uninsured individuals added up to
1,220 in 2019. If you need diagnostic testing,
life - saving care, or emergency transportation,
that number climbs even higher. Emergency Room
Costs with Insurance Even when you do have
health insurance, ER visits may cost you a pretty
penny. Your emergency medical care coverage
depends on your plan, insurance company, and
state, but in any case, you can expect to pay a
high copay, shell out for a large percentage of
coinsurance, or meet a deductible before your
coverage takes over.
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• With the most thorough and comprehensive health
  insurance plans, copays for ER visits start at
  around 150. While that amount covers the initial
  costs of getting seen in an emergency medical
  facility, your payments might not stop there.
  Theres a chance youll have to pay extra for
  tests and diagnostic services, medications, and
  emergency transportation.
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• If youre required to meet a deductible before
  your insurance covers an ER visit, and if your ER
  bill is more than your deductible, youll have to
  pay the full deductible all at once, which may be
  thousands of dollars. Then, your insurance will
  cover the rest of the medical claim.
• Unfortunately, emergency room bills are often
  even more complicated than that. If you are seen
  by an out-of-network doctor during your visit
  (and yes, thats possible even in an in- network
  medical facilitymore on that later), you may
  receive a surprise bill. Or, if your ER claim is
  denied, you may suddenly be responsible for a
  bill in its entirety, even if you have health
  insurance.
• Is your emergency room bill going to break the
  bank? aJust is a pro at negotiating ER bills.
• Why Are Emergency Room Services So Expensive?
• Emergency room costs are notorious for being sky
  high. Here are a few reasons why you may be
  charged more than you were expecting after an ER
  visit
• Emergency Transportation. If youve been in an
  accident, are dealing with a life-threatening
  condition, or are simply unable to get to the ER
  any other way, you may be brought to the medical
• facility in an ambulance. In emergent situations,
  you dont have a choice but to accept a ride,
  which, depending on your insurance, may cost you
  heavily. Add that to the rest of your ER bill and
  youre
• looking at some serious medical debt.
• Out-of-Network Services. Its estimated that one
  in five ER visits results in a surprise bill due
  to an out-of-network provider or service. Even if
  a hospitals trauma center or an emergency room
  is within your insurance network, its possible
  that one of the doctors who attends to you (or
  reads your X-ray, for example) is not contracted
  with your insurance. This means that your
  insurance will only cover their services at a
  lower rate or not at all, leaving the rest of the
  bill up to you.
• Not Medically Necessary. Some insurance plans may
  deem an ER visit not medically necessary. For
  example, if youre concerned about the sudden
  onset of chest pain, you may head to the
  emergency room. There, the ER doctors run a
  series of tests and determine that the chest
  pains are due to heartburn, not an emergency
  condition. Because the doctors need to note the
  diagnosis when filing a claim to your insurance,
  your insurance will see the reason behind the
  visit. If they then determine that the ER visit
  was not medically necessary, they may deny the
  claim. As the patient who was trying to avoid a
  life-threatening situation, this feels unfair!

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• ERs which are equipped to handle different kinds
  of emergencies. If you need a level one trauma
  center but the nearest one is not in your
  insurance network, youre out of luck. This can
  happen even if you subscribe to an insurance plan
  with comprehensive ER coverage.
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• Cost of Assembling the Team. Youve probably read
  stories online about people who visited the ER
  and were released with a Band-Aid or a few
  stitches, only to get sent a several-thousand-doll
  ar bill. Because ER prices are not regulated in
  the US, each hospital director is allowed to
  choose their own facility fee. This fee is
  required of each patient, and goes towards the
  costs of keeping an ER open 24/7 and staffed with
  highly trained doctors, with quick access to
  expensive medical equipment and all types of
  medications. Because of this, you may get simple
  treatment at the ER and end up with an
  unexpectedly enormous medical bill. Again, this
  doesnt feel fair!
• Markups. If youve ever been to the ER only to be
  given ibuprofen and told to rest, youve probably
  seen that the over-the-counter medicine costs
  significantly more there than it would at your
  local drugstore. You may even pay hundreds of
  dollars for an over-the-counter remedy! Just like
  with the facility fee, youre not just paying for
  the medication, but also for the fact that the
  emergency room has so many medications in stock.
  The problem is, you arent warned of these
  markups, and
• therefore dont know to ask if you can take the
  medication at home instead.
• Components. An ER visit isnt covered by a flat
  fee. There are several components that make up
  the bill sent to your insurance, such as triage
  fees, facility fees, professional fees, equipment
  fees, and supply costs. The emergency room costs
  you accumulate also may vary based on the
  severity of your case.
• How to Lower an ER Bill?
• Due to the lack of transparency about hidden
  costs like out-of-network physicians in in-
  network facilities, and because youre likely to
  be brought to the ER in no condition to advocate
  for yourself, avoiding high ER bills is
  difficult. Luckily, lowering them is somewhat
  easier. Here are a few strategies at your
  disposal
• Fight an ER Claim Denial. If your emergency room
  bill is the result of a denied health insurance
  claim, your best course of action is to fight the
  denial. That means filing an appeal with your
  health insurance company and providing supporting
  documents in the hopes that they will reverse
  their decision. Just keep in mind that this is a
  large undertaking that can zap your time and
  energy.
• Negotiate an ER Bill. While theres no guarantee
  this strategy will work, you can always try
  calling the ERs billing department and asking
  for a reduced rate. Some facilities will offer a
  discount if you pay quickly in one lump sum, or
  will offer you an insured or Medicare rate even
  if you dont qualify for it. The challenge here
  is knowing how to negotiate an ER bill!

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• Hire a Medical Billing Advocate. The most secure
  and convenient option is to hire a medical
  billing advocate like aJust. This advocate will
  audit your emergency room charges, make phone
  calls on your behalf, and use their knowledge of
  the system to get you the greatest discount
  possible.
• Why Call on aJust for Help with Emergency Room
  Bills
• Large emergency room bills have a way of making
  bad situations even worse. Because the ER billing
  system is not straightforward and varies so much
  based on the will of the hospital directors, its
  impossible to know as a patient which bills can
  be adjusted and how. If there is any situation in
  which you need an expert on your side, its with
  emergency room billing.
• So let aJust take over, dealing with both the
  insurance company and the medical facility in
  order to find a solution that saves you money.
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