Why Are Emergency Room Bills So High?

If you’ve ever had to visit an emergency room (ER) for a medical emergency, you know how stressful and scary it can be. You also know how expensive it can be, even if you have health insurance. According to a study by the Health Care Cost Institute, the average price of an ER visit in the US increased by 176% from 2009 to 2018. That means a typical ER visit can cost you thousands of dollars out of pocket, depending on your condition, treatment, and insurance coverage.

But why are ER bills so high in the first place? What factors contribute to the skyrocketing costs of emergency care in the US? And what can you do to avoid or reduce these bills if you ever need to go to the ER? In this blog post, we’ll try to answer these questions and provide some tips and resources to help you navigate the complex and confusing world of ER billing.

Key Takeaways:

• ER bills are high because of the costs of providing 24/7 emergency care, the fees and charges involved, and the use of out-of-network providers.
• You can avoid or reduce ER bills by knowing when to go to the ER and when not to, knowing your insurance coverage and network, asking questions and getting an itemized bill, and negotiating or disputing your bill.
• You can use some resources and tips to help you navigate the complex and confusing world of ER billing.

The Reasons Behind High ER Bills

There are many reasons why ER bills are so high, but some of the most common ones are:

• ERs are open 24/7 and treat all patients regardless of their ability to pay. This means that ERs have to cover the costs of staffing, equipment, supplies, and overhead for providing round-the-clock care to anyone who walks in the door, including uninsured and underinsured patients who may not be able to pay their bills. ERs also have to deal with a lot of uncompensated care, which is the difference between the cost of providing care and the amount they receive from patients and insurers. According to the American Hospital Association, hospitals provided $41.6 billion in uncompensated care in 2019.
• ERs have to be prepared for any kind of medical emergency. This means that ERs have to stock a wide range of drugs, devices, tests, and specialists that may not be available or needed in other settings. For example, an ER may have to keep a supply of antivenom for snake bites, or a trauma surgeon for gunshot wounds. These specialized services and resources are often very expensive and may not be used frequently, but they have to be available in case of an emergency.
• ERs charge facility fees and professional fees. A facility fee is a charge for using the ER’s space, equipment, and staff. A professional fee is a charge for the services provided by the doctors, nurses, and other clinicians who treat you. Both fees vary depending on the level of care you receive, which is determined by the complexity and severity of your condition. For example, a level 1 facility fee is for minor problems like a sore throat or a sprain, while a level 5 facility fee is for life-threatening problems like a heart attack or a stroke. The higher the level, the higher the fee.
• ERs often use out-of-network providers. An out-of-network provider is a doctor or other clinician who is not contracted with your insurance company. This means that they can charge whatever they want for their services, and your insurance company may not cover them at all or only pay a fraction of their fees. This can result in surprise bills that you have to pay out of pocket after your visit. According to a study by the Kaiser Family Foundation, 18% of all ER visits resulted in at least one out-of-network charge in 2017.

The Ways to Avoid or Reduce High ER Bills

While there is no easy solution to the problem of high ER bills, there are some steps you can take to avoid or reduce them if you ever need to go to the ER. Here are some tips and resources that may help:

• Know when to go to the ER and when not to. The ER should only be used for true medical emergencies that require immediate attention and could be life-threatening if left untreated. Some examples are chest pain, difficulty breathing, severe bleeding, loss of consciousness, or signs of a stroke. For less urgent problems that are not emergencies, such as minor infections, rashes, or injuries, you may be better off going to an urgent care center or your primary care provider instead. They are usually cheaper and faster than the ER.
• Know your insurance coverage and network. Before you go to the ER, check your insurance card or call your insurance company to find out what your plan covers and what your copayments and deductibles are. Also ask if there are any in-network ERs near you that you can go to. If possible, avoid going to out-of-network ERs or providers that may charge you more or not be covered by your insurance.
• Ask questions and get an itemized bill. When you’re at the ER, don’t be afraid to ask questions about your treatment and charges. Ask for an explanation of what tests, procedures, drugs, or services you’re getting and why you need them. Also ask for an itemized bill that shows the breakdown of all the charges and fees you’re responsible for. This can help you spot any errors, duplicates, or unnecessary charges that may inflate your bill.
• Negotiate or dispute your bill. If you think your bill is too high or unfair, you can try to negotiate or dispute it with the hospital or the provider. You can ask for a discount, a payment plan, or a charity care program that may reduce or waive your bill if you qualify. You can also challenge any charges that you think are incorrect, excessive, or not covered by your insurance. You may need to provide evidence, such as medical records, receipts, or statements, to support your claim.

Conclusion

ER bills are high because of many factors, such as the nature of emergency care, the fees and charges involved, and the use of out-of-network providers. However, you can avoid or reduce these bills by knowing when to go to the ER and when not to, knowing your insurance coverage and network, asking questions and getting an itemized bill, and negotiating or disputing your bill. By following these tips and using these resources, you may be able to save yourself some money and stress if you ever need to go to the ER.