You’re relieved. You went to the closest emergency room with stomach pain that turned out to be indigestion from a spicy burrito.
After some tests and a prescription for an acid reducer, you’re ready to go home and relax.
Then, on your way out the door you get something that nearly gives you a heart attack – a bill for almost $4,000, none of which is covered by your insurance!
Beware of where you seek care
But wait … isn’t emergency care always covered?
The answer: It depends.
Two major factors come into play:
- Do you have an emergency condition?
- Is this ER part of your health plan’s network?
All conditions are not equal
It is true that all ERs are required by federal law to perform a basic medical screening to determine whether you have an actual emergency medical condition. If you do, they are required to treat you, regardless of your ability to pay.
So what are emergency medical conditions? These include things like:
- Chest pain
- Shortness of breath or difficulty breathing
- Severe bleeding or head trauma
- Altered mental status, like confusion or loss of consciousness
- Sudden dizziness, weakness or changes in vision or speech
- Severe or persistent vomiting or diarrhea
- Severe abdominal pain
- Severe headaches
- Dehydration
- A dangerously high fever
- Badly broken bones
- Serious burns
- Poisoning or bites from poisonous snakes, insects, etc.
Unless you have a serious or life-threatening condition, an ER is not where you need to be. You’d be better off consulting your primary care doctor or going to a walk-in clinic or urgent care center. You can get the care you need, and the cost will be much lower.
All ERs are not equal
Independently owned, free-standing emergency centers are popping up all over the country, including a few in Arkansas.
These ERs are different because they offer emergency care but are not contracted as in-network providers in Arkansas Blue Cross’ networks.
What this means is that you might get a hefty “balance bill” from the facility for the care you received, representing the amount charged by the facility that is not covered by your health plan. And while such an ER might stabilize you, it may not be able to provide as broad a range of acute care that you might need the way a hospital can.
To learn whether an ER is part of your health plan’s network, check your health plan’s online provider directory or call the customer service number on the back of your member ID card before going there to receive care.
Seeking care in the right place saves you time, money and aggravation.