Emergency Room Insurance Coverage
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UPDATED: Mar 13, 2020
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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.
There are a couple of things to look out for in this scenario.
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.
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.
Watch Out for the Emergency Rooms and Urgent Care Markup!
It is not abnormal for emergency rooms to charge much 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% markup…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% of the emergency room charge, or the first $500 dollars of the cost for care.
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.
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.
Review your current policy with your independent agent or HR department if you are not sure about your current emergency room visit coverage.
I recommend getting quotes online or contacting 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.