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Why is it so Expensive to Visit the Emergency Room?

This article details how a visit to the emergency room can be so costly and why health insurance can help.

A trip to the emergency room is something that all of us want to avoid at all costs - which today, can be quite high. Take this story, for example, of two parents who took their baby to a San Francisco hospital after an accidental fall off a hotel bed earlier this year. After a little more than three hours of treatment (which consisted of a nap and some formula), the baby was discharged with a clean bill of health.

The cost of this visit - $18,836. Much of this was attributed to a “trauma response fee,” which amounted to $15,666.

The other strange part of this story is that it took two years for the bill to arrive. The family had all but forgotten about the incident, but now had an $18,836 reminder.

So why does it cost so much to go to the ER? As you might expect, it’s complicated.

Everything Costs More in the ER

Nobody wakes up knowing that their day may include a trip to the ER, but these things do happen to the best of us.

Let’s say you unexpectedly faint due to some unknown circumstance, and while falling, you hit your head on a table. You feel okay but to be on the safe side you want to get your head checked right away. You have a friend drive you to the hospital and after filling out the required paperwork, you proceed to wait.

Finally, your name is called and you are rushed in to see someone. The attending k a series of questions, provide an Ace bandage and an ice pack, then send you home with no actual diagnosis. That person you saw wasn’t an actual doctor.

Now how much do you think all of this would cost? It would depend on the state and facility. So let’s use the Hoboken University Medical Center in New Jersey for this example. So we’re talking basic triage, Ace bandage and an ice pack to go. Can you guess how much the bill would be?

If you’ve guessed anything less than $5,751, you’d be mistaken.

That’s some expensive ice pack!

Insurance Does Not Cover the Total Cost

If you have a health insurance plan with a very low monthly premium, you may have a cap of around $250 on Emergency Room expenses - which doesn't even begin to pay for the costs of an average ER visit.

There’s also the added complication of the treatment being “in network” or “out of network.” And you have to be careful, because you can have “out of network” doctors working in facilities that are “in network,” which you might only find out once you get the bill (two years later, in some cases).

In the Hoboken example above, the person’s health insurance only paid $862, which was 17% of the total bill, and left around $5,000 remaining. Keep in mind that there were no ambulances involved - or any treatment from a licensed doctor.

This is just one example of someone fainting. Imagine if it was really something serious like a broken bone - or worse.

Emergency Rooms: High Demand with No Competition

If you do have an emergency, there’s not too many options for getting medical treatment right away. If you’re in extreme pain or rushing to save a loved one, you will race to the nearest ER, not stop to compare the costs of the ER a mile away to the one ten miles away. This has created a situation where there’s high demand with no competition, which critics have called a monopoly at the expense of the patients. As you may have discovered at some point in your life, ERs are the only option in some situations - especially if it’s late at night or a weekend.

This is why most gas stations in the same area have similar pricing - there’s high demand with a lot of competition. They all want your business, and no one wants to have the most expensive prices on the block. They’re in competition for your business, which benefits the consumer.

No Transparency

A trip to the ER is not a trip to a restaurant. There’s no menu and you cannot find a set list of pricing on anything in the ER. - When you come into an ER there are medical protocols and it’s the medical experts who will decide what tests to run. But the people treating you are not the people charging you and so even if you ask how much a MRI or CAT scan will cost, you will most likely get the treatment without first knowing the price.k. While there is little transparency in ER billing, there has been analysis, that indicates the cost of getting emergency care treatment has doubled in the last eight years.

If you knew you could get the same treatment for half the cost at an emergency room 10 miles down the road, would you want to go there? And, if less people went to the most expensive ER, maybe this facility would be motivated to lower their prices.

Facility Fees: The Hidden Cost

There is a cost included with your ER bill that is separate from any actual treatment you receive, which is known as the “facility fee.” No matter what you come to the facility for, you will be charged a “facility fee” for access to the ER. The facility is often based on the severity of your condition, but severity is something determined by the ER, not by you and not by an open standard. So again, you can’t predict the bill.And it can can take weeks, months, or years before you see the final bill.

It’s Expensive to Run an Emergency Room

Emergency medical care, and the complexities involved in diagnosing and treating everything from food poisoning to a brain injury, is expensive. hIt cost a lot of money to keep an emergency room open and running at all times with a highly trained, often specialized, paid staff. They have to be ready at all times, for anything and anybody who passes through the door.

In addition to the cost of providing medical care, there is the cost of doing business -- electrical and utility bills, keeping the rooms fully stocked, food, and other little things needed. Unfortunately these expenses get passed down to the people who use the services.

Is There Any Hope?

It’s never too late to change. When you or a loved one is ill or injured, it’s hard to calmly decide whether the condition is mild enough to be handled by an urgent care facility, or serious enough that you should go straight to the ER. And when you or a loved one is in severe pain, the last thing you want to focus on is the cost of a lab test. Your priority is getting treatment.

The best way to protect yourself in an emergency is to make sure you have health insurance that covers trips to the ER. And you should understand your policy. When you purchase health insurance, consider how much you can afford to pay out of pocket vs how much money your insurance will contribute to ER services. Know which facilities are in network. Know where to go.

Luckily, there are many health insurance plans that provide a range of coverage options for ER visits.

Balancing your benefits with the cost of a health insurance policy is a very personal decision that only you should make. Luckily, AgileHealthInsurance.com has tools available to help you compare all the options.

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