Health Insurance: How the Emergency Room and Urgent Care Billing Works

If you are in a bad accident, it’s clear that you will need to go to the nearest ER. Simply because the emergency room is the department in a hospital that deals with emergencies, and you do not need an appointment to get medical care.

But emergencies can vary, and others will not be as clear cut as a bad accident. It is best for you and the insurance company if you can decipher between emergency room vs. urgent care, which is appropriate under the circumstance.

In either case, be it a walk-in clinic or an emergency room near you, you need to be ready to answer all the queries about your health insurance and medical history. You can also be required to decide whether you can undergo specific procedures and tests.

Preparedness will ensure that you will avoid huge bills. It is best to choose the right health insurance cover that is widely accepted and better yet one that can be used in Express ERs.

Emergency Room vs. Urgent Care

If you are concerned about medical debt, you will have to settle the debate over being treated at an emergency room vs. urgent care or a walk-in clinic. This is true, especially for a family or people who do not experience many “urgent” or “emergency” situations facing them each year.

To this debate, there are many sides to it, but the accepted guidelines for choosing between urgent care and the emergency room is as follows:

  • If you are experiencing minor conditions like allergic reactions, broken bones, bites, flu symptoms, fever, and the like, urgent care is best for you since it will save you both time and money.
  • If you have a severe medical condition like you are involved in a bad accident, or you have a stroke, then the resources available in an emergency room will be the best choice.

In other words, if it is not a life-threatening scenario, then urgent care is the best option. This is vital since there are some scenarios where insurers will shift the medical bill to you after reviewing your case only to find that it wasn’t an ER worthy emergency.

As a general rule, urgent care will cost less than emergency room visits. However, you must check out the insurance plan if it’s from Cigna, Aetna, Blue Cross Blue Shield, or United Health Care, which we accept in our facility.

Does Insurance Cover ER or Urgent Care Visit?

If the situation warrants it, go to our emergency room and be confident knowing that your insurance be it from Blue Cross Shield or Aetna, will cover it. Under Obamacare (Affordable Care Act), health insurance plans cover emergency services.

Also, under the same act, you cannot be charged higher coinsurance or copays if you need to go to an out-of-network ER.

Another essential thing to note is that under Obamacare, you have ER rights, and you do not need to get approval beforehand to receive treatment. Remember, it has to be an “emergency.”

You need to be careful since different insurance plans define emergencies slightly differently from each other. You might get into the ER and spend thousands of dollars.

It is best to note that being “covered” doesn’t mean that you might not be charged out-of-pocket.

You should note that even if you are covered, there are times when it can cost you an arm and a leg, all of which can be out-of-pocket. If you go to an out-of-network doctor or hospital, this will probably increase your bill. If you take an ambulance and the insurance discovers that it was unnecessary, it will also cost you some more.

How ER Billing Works

If you are not careful, you can end up coming out of the ER with a high medical bill, depending on your insurance plan and where you go to receive treatment. This is because of balance billing.

What you might not know is that every insurance company has a negotiated rate with the emergency room. In simple terms, the insurer will tell the ER that they will pay the physicians and the hospital a certain amount for the services you will receive.

You will be responsible for paying whatever the insurance plan says within that negotiated rate like deductibles.

It would help if you knew your insurance plan well, and at Express ERs (Main Site), we accept insurance cover mainly from Blue Cross Blues Shield, Aetna, Cigna, and United Health Care.

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