October 22, 2018

Emergency Room Questions: How Your Emergency Room Benefits Work?

Emergency Room Questions: How Your Emergency Room Benefits Work?

Whenever a need to visit the emergency room arises, the first reaction is always to place a phone call to 911—and not to start wondering how much that particular visit will cost you. In the event of an emergency, receiving the right care and treatment, and getting it soonest needs to be the main focus. 

If you are experiencing a heart attack, you will not have the time to inquire whether the attending doctor takes insurance or not. However, Frontline ER recommends that you be aware: that the lifesaving trip that you just made to the emergency room is likely to come with a very high price tag. 

ER Bills and Past Statistics

Much of this centers on data derived from a survey of uninsured and insured people who found it hard to pay for their medical bills. A closer look at the medical bills revealed that a large percentage of the money that was owed was partly taken up by ER related bills. 

But this is not to mean that visiting a facility that accepts insurance will automatically lead to lower medical bills. The reason for this according to Frontline ER is quite simple: around two-thirds of all the doctors working in an emergency room are independent contractors. It means that there is a huge possibility that they are not in your insurance policy. 

And this means that the laboratory or the out-of-network doctor is likely to later bill you for any amount that was not covered by your insurance policy. This practice is popularly known as balance billing. There is always a whole cast of health care providers involved in providing services in an ER, many of whom you will not even get to meet, yet they will bill you for services rendered. 

Additionally, if the ambulance firm that took you to the Frontline ER does not accept insurance payments, the out-of-network costs will continue to rise. It is often subjective to the kind of care provided before you arrived at the hospital and the location from where you got picked.

Although it is not possible to protect yourself from such costs, you cannot afford to place expenses ahead of getting the required medical treatment when you are dealing with an emergency. However, some of these benefits can prove beneficial.

Make Sure You Have a Good Understanding of Your Insurance Policy

You need to request the insurance company for proper documentation detailing the coverage details if you need to receive emergency care. The information provided on the insurer’s handbook and website may not always be up to date.

For instance, make sure that you get clarity on the ER coinsurance and copay, including what your insurance plan will cover, and what it will not if you get admitted. The insurance company may also provide you with vital information on which local hospitals accept insurance. 

Armed with this information, you can make inquiries from the hospital’s billing department on whether the doctors working in the ER participate in your health insurance plan. 

Questions You Need to Ask Once You Are at the Hospital

Whenever you call 911, the dispatcher will typically send the ambulance that is closest to you. It is not possible to know in advance whether they are in your insurance network. Although you can request to go to a specific Frontline ER facility, the ambulance staff has the final say, and in most cases will settle for a facility that is closer to you.

Often, they decide on where to take you based on the facilities available. For instance, you may be in a situation that requires you to have a CT scan; this means that the personnel will take you to the hospital they know has this type of equipment.

Under the terms defined in the Affordable Care Act, if you are a patient who needs emergency care, your coinsurance or copay should not be higher than the in-network rates, even if you end up in a hospital that is not within your network. However, the law does not make it impossible for out-of-network providers to bill you for the remaining amount after your treatment. 

On arrival at the hospital, a friend, neighbor, or family member who accompanied you will need to fill in some forms before admission. It will be the appropriate time, if possible, to place a request for an in-network physician or another healthcare provider. When being discharged, make sure that you request for, and retain all the paperwork. It should include an itemized list indicating all the charges billed to you.

But what happens if you get an out-of-network health care provider? 

In such a case, you will most probably end-up receiving different medical bills for each provider that treated you in the ER. At Frontline ER, we recommend that you do not make any payments until you receive an EOB (explanation of benefits) statement from the insurance company. The account will help provide clarity on what your coverage is and what you need to pay out of pocket. 


Emergency Care, Emergency Room