Emergency Room Lessons for the Day

June 4, 2018

Interesting, but sad story of a man admitted to an in-network emergency room only to emerge with an $8,000 bill.

Perhaps more so than any hospital stay, emergency room (ER) visits can become very costly very quickly. Here, the patient thought he was covered because the facility was in-network for his plan, only to find out that the doctor who treated him was not and had billed him personally a whopping $7,924 for the work he had done. My intent here is not to bash the doctor or the system for overcharging, any casual observer or client of our healthcare system knows full well that these costs have grown out-of-hand, but to share a few lessons valuable to health insurance beneficiaries.

1) Prepare yourself for an emergency. Research in advance to ensure that all facilities, doctors, and tests will be in-network should you find yourself needing an emergency room. This may mean researching several local hospitals to ensure you'll be taken to the facility best covered by your plan. Once you're in the ambulance, it's too late!

2) Use Urgent Care Centers when possible. Their rates are generally more favorable than a hospital ER.

3) When shopping for health insurance, ensure that you know what your personal financial exposure will be should you be admitted. Your plan's deductible is a good starting point - what is it and how will your insurance reimburse you once you've hit it? Many Medicare Advantage plans have a MOOP (Maximum Out Of Pocket) level which will seriously curtail your hospital expenses should you find yourself in for an extended stay.

3) Finally, don't let the hospital staff keep you "under observation" in the ER for too long. Occasionally, staff will want to observe your progress instead of admitting you to the hospital immediately. Nobody wants an unnecessary hospital vacation, but financially, you'll likely be better off in a hospital bed than hooked up to a bunch of monitors, languishing in some of the most costly real estate in the building. Urge your healthcare providers to "Admit" or "Release."

I am always to happy to answer your healthcare insurance-related questions. Please visit my website: www.healthbenefitscounseling.com for more information.