Emergency Room Insurance Coverage

If you’ve ever been to the emergency room at a major hospital, you probably swore never to return.

Of course, when you’re seriously injured or ill and can’t visit your primary care physician or network preferred doctor (if dealing with a PPO), all bets are off.

You’ll likely put up with the long wait in an overcrowded room with seemingly disconnected staff.

But the real concern is whether your health insurance company will pay for your emergency room services.

What should you look for in a scenario like this one?

First and foremost, you will need to notify your insurance company within a pre-determined amount of time of your visit to the ER or you’ll be out of luck.

The typical insurance plan requires notification within 48 hours, as there are not a lot of situations where you would need more time.

For instance, if your emergency room visit took place on the weekend, you’ll most likely be able to notify them within two days.

The 48-hour period may be waived in the event you are so seriously injured that you’re unable to contact anyone, or have a condition that made it impossible to do so.

However, a family member may be expected to notify the insurance company on your behalf in the event you cannot.

Also, many health insurance companies have previously agreed upon dollar amount costs for certain types of care, especially if you are in an HMO or PPO network. (For more information, read our “Types of Health Insurance Coverage“).

Are there any sort of markups for emergency room or urgent care visits?

It is not abnormal for emergency rooms to charge way more money for the same services if they don’t have existing contracts with your insurer.

Convenience and immediate service come at a cost. Think about when you purchase a dozen roses on Valentine’s day versus purchasing them one month in advance.

You’re easily paying a 400 percent markup, and unfortunately even though it’s for medical care and not flowers, the emergency room works the same way.

Depending on what type of coverage you have, you may be responsible for a percentage or flat rate deductible copay for your visit.

For example, you may have to pay the first 20 percent of the emergency room charge, or the first $500 dollars of the cost for care. Further than that, if you have an even higher deductible, you may be expected to pay out for your emergency care visit until you reach it.

One of the reasons for the higher deductible is that numerous studies show many ER visits could have been avoided if proper steps were taken through your primary care physician to ensure you maintain overall good health. Most patients who visit the ER have symptoms that they’ve never seen before or are in severe pain, and even if it happens to be a life saving visit, the treatment you receive could end up being quite costly.

As you are probably aware, it is in your best interest to avoid a visit to the emergency room for these reasons, and maybe even more so for insurance related purposes. Take your symptoms seriously though, and don’t just ignore them. If you find yourself needing emergency services, your health comes first.

Medical emergencies like this do happen, so it’s better to be prepared and talk to your insurer about what they protect you from in terms of the subsequent medical bills after an emergency department visit.

Review your current policy with your independent agent or HR department if you are not sure about your current emergency room visit coverage. Leaving it up until the last minute can cause a person unnecessary stress. When you’re rushing to the emergency room because you’ve never experienced allergic reactions before and don’t know what’s happening, you’ll want peace of mind that the visit isn’t going to come with high medical costs.

The recommendation for most people who are unsure about what they’re provider covers in terms of medical services is to look at quotes online or contact an independent insurance agent for a quote, if you intend to purchase health insurance coverage.

It’s the best way to ensure you get appropriate coverage at the lowest possible rate.