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Why your emergency room costs are so high

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Updated on April 5, 2017

Annual ER visits have increased 34% between 1995 and 2010, with emergency department visits reaching 130.4 million. Americans are becoming more concerned about how much emergency care costs. Patients spend hours of their time in emergency rooms due to significant overcrowding and spend some additional hundreds (or thousands) of dollars for the visit. Wait times in urban areas can be over an hour, not even including treatment time. The average cost of an ER visit is somewhere around $2,168, although some patients pay much more.

Why Costs Are High

Despite medical insurance, patients are being billed for services believed to be covered, especially in emergency rooms. Frequently, emergency physicians are part of an independent group working out of the hospital, and therefore their services are billed separately from the hospital’s. While the hospital you attend may be “in-network” with your insurance, the physician group taking care of you may not. There is a law in place that states you cannot be billed more for attending an emergency room out-of-network, however the physician group can bill you for whatever your insurance does not pay. This practice is called balance billing and can lead to substantial, intimidating medical bills for patients.

Patients are frequently surprised with high medical bills. For example, a North Texas mother was surprised with a bill of $6,000 because one of her doctors was out-of-network at an in-network hospital. Unfortunately, this is a common occurrence across the country – hefty bills affect even those who are insured. According to Centers for Medicare and Medicaid Services (CMS), about 50% of emergency visits still go uncompensated.

Per the Kaiser Family Foundation, approximately 28.5 million non-elderly Americans remain uninsured. So many Americans remain uninsured because of the exorbitant cost of the insurance itself. Due to increasing copays and deductibles for those with insurance, outpatient testing and specialist visits often get delayed or even ignored.

Because patients choose to delay care, more emergency rooms are seeing patients with chronic conditions who present worsening symptoms and complications. This isn’t because they have inadequate doctors, but because the necessary care they need is unaffordable. When problems worsen, patients rush to the ER for illnesses that could have been prevented by normal doctor visits.

Urgent Care vs. Emergency Rooms

Urgent care centers are becoming more popular because of their convenience and lower costs. For the average insured patient, the average cost is around $45 and for self-pay around $185. Most urgent cares accept a majority of insurances, and typically charge significantly lower co-pays than emergency rooms.

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Nevertheless, urgent care facilities have their limits. Urgent cares cannot typically draw blood work or run complex testing like CT scans. Patients are often uneducated on the major differences between emergency rooms and urgent cares, but cost and convenience are their main concerns. While urgent cares are not open 24/7, as many as 95% close after 7pm and are open seven days a week. In fact, it’s estimated that as high as 84% of ER visits are not actual emergencies and can be taken care of at urgent care.

Some of the most common complaints in the emergency room include:

  • Sprains, strains and broken bones
  • Abdominal pain
  • Chest pain
  • Kidney stones
  • Falls
  • Shortness of Breath

Some of the most common complaints in urgent care facilities include:

  • Sprains, strains and broken bones
  • Urinary Tract Infections
  • Strep Throat
  • Yeast Infections
  • Lacerations

The average bill for an emergency room visit for a urinary tract infection is $1,975. At an urgent care, patients can usually be in and out in around thirty minutes and pay approximately $50-$150. For patients who aren’t in need of emergent care, visiting an urgent care center may be a better option.

Ambulance Care

Not all emergencies can wait for a drive to the hospital – approximately 16% of ER patients are estimated to arrive by ambulance. Sources estimate a range anywhere from $300 to $2,000 for an ambulance ride. For Medicare beneficiaries, the coverage for ambulance services can be denied if the condition is not life threatening enough.

Regardless of cost, patients need to be aware of when going to the emergency room or calling an ambulance is necessary. Some of these symptoms and conditions include:

  • Signs of a Stroke: slurred speech, weakness or numbness on one side, facial droop, and difficulty walking
  • Signs of a Heart Attack: chest, jaw or arm pain
  • Shortness of Breath
  • Signs of a Severe Allergic Reaction: Tongue or throat swelling, difficulty breathing
  • Passing out
  • Head injuries
  • Uncontrollable bleeding