Are Emergency Room Visits Covered by Insurance?

Are Emergency Room Visits Covered by Insurance?

Accidents and diseases can catch up with someone unexpectedly. This can be scary when you go to the Emergency Room for treatment and you don’t have the money to pay for the treatment or a medical insurance cover.

The good thing is that the Affordable Care Act in the United States laws calls for insurance companies providing health insurance to provide coverage for Emergency Room services. The insurance is to be provided regardless of the place you have sought ER treatment from; even if it is abroad. Also, insurance cover will be provided to anyone regardless of whether the ER they visited is in their subscribed network or out.

The provision, however, caters for certain medical conditions. Not all visits to the Emergency Room will warrant you coverage. Only serious medical conditions can be insured and these include illnesses, injuries and conditions or symptoms that require urgent medical care.

In the event that you find yourself in an emergency situation, it is advisable for you to rush to the nearest Emergency Room regardless of whether it is within your insurance network or not. There is no provision that requires you to get prior approval from your insurance provider. They will cater for the incurred expenses except for any deductibles and copayments.

While Emergency Room visits are to be catered for by insurance companies, a patient can expect some copay. This amount usually averages anywhere between $50 to $150. It could be slightly more. The extra costs are usually waived if you happen to be admitted. Coinsurance can range anywhere between 10% and 40% depending on your insurance plan.

Typical Cost Incurred in Emergency Rooms

The cost for a typical visit to the Emergency Room will cost someone with no insurance cover anywhere between $150 and $3000. The various services offered to you are usually charged separately thus the large cumulative cost. Diagnosis may include X-ray checks, laboratory services, and possibly a minor surgery. Each of these services has a bill attached to it. You, also, will receive a bill for the room they used for your treatment.

These are just but a few of the things that you can expect to pay for if you do not have insurance coverage. In the event that your condition is severe and it requires an advanced treatment procedure like surgery or admission in the hospital, the cost could go up to tens of thousands or more. An average person may not be able to cater for these costs and that is why it is very important for someone to have medical insurance.

Important considerations in the event that you have to visit the ER

Insurance providers are companies in business. They will always look for reasons not to pay for your treatment or even pay less than what you expect. They have been a good number of cases that have arisen of people’s bills not being paid by their insurance companies because of some minor reasons. To be on the safe side, here are a couple of considerations to take note of:

Know when to visit an Emergency Room

Emergency Room visits are very costly compared to visiting urgent care centers. It is stated that most people who visit Emergency Rooms go there for minor illnesses or injuries that can be easily treated in urgent care centers. If your insurance provider does not categorize your condition as severe, they will not cater for the treatment bills. As such, it is important to know the severe conditions that actually warrant one a visit to the Emergency Room to avoid having to bear unnecessary costs.

Notify your Insurance provider as soon as possible that you have received treatment in an ER

You need to inform your insurance company that you have gone to an Emergency Room for treatment within a specified period of time. One is usually required to offer the notification within 48 hours of their visit. Otherwise, you may have to foot the cost of your treatment.

Know exactly what your insurance plan caters for

It is, also, important to know what kinds of medical conditions the insurance plan you have purchased caters for. This will help you avoid the situation where you confidently go for treatment in the ER but your insurance company fails to foot the treatment costs. You then end up being slapped with unexpected medical bills that you may not be able to bear. As such, it is crucial for you to know what exactly are catered for in your insurance plan.

Bellaire ER is a licensed emergency care provider in Texas that strives to provide the most reliable emergency care to its patients. We have a team of very experienced physicians who are ready to offer our patients reliable and quality medical care within the shortest time possible.

In addition to the quality care you will receive from us, you can, also, expect clean waiting rooms that are very spacious, a peaceful and elegant atmosphere and a staff that is ready to listen and attend to your needs within the shortest time possible.