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Coping With Emergency Room Sticker Shock

Going to the emergency room is stressful enough. Getting a bill later that's been larded with unexpected charges could derail your recovery.

While the new health law should make getting the ER bill a little less painful, you need to eyeball the charges closely if you want to avoid paying more than you should.

One of the biggest and priciest problems consumers face if they happen to become sick far from home or far from their insurance plan's preferred hospital is what's called "out-of-network" charges for treatment.

A health plan may cover only 70 percent of the charges in such cases, instead of the 80 percent it might typically cover for a local ER visit, says Christie Hudson, vice president for Medical Billing Advocates of America, a company that helps consumers with medical billing problems.

And that can be financially devastating to a patient with a serious injury. 

Starting this fall, out-of-network charges may be less of a concern. New health plans won’t be able to charge more for out-of-network emergency services than they would for in-network ER care. However, many existing plans will be "grandfathered" in, so check with your plan about the rules.

But there are plenty of other ER charges besides out-of-network fees to look out for, say consumer advocates. Other charges a patient might consider challenging include:

  • Charges for equipment or services that should be included in the cost of the ER room, including charges for monitors, supplies and nursing services;
  • Charges for a comprehensive visit when a patient is only being treated for a minor illness or injury;
  • Charges for keeping a patient in the ER under observation at a higher cost than what would have been charged if the patient had been admitted to the hospital’s intensive care unit.

  • Your first step in avoiding overpayments is to request an itemized bill that spells out all the charges, rather than the summary bill that hospitals typically send.

    If there are charges you don’t understand, call the provider and ask for an explanation. If you’re not getting anywhere, consider working with a consumer medical billing assistance group like Medical Bill Advocates. They’ll work on your behalf, typically for 25 to 35 percent of whatever amount they save.

    Or check here for a list of nonprofit organizations that can help sort out medical bills.

    Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

    Michelle Andrews
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