Having a medical emergency is scary. Then there are all the insurance questions that run through your head. Will this emergency room be covered by my insurance? What portion will I be responsible for paying? How many bills will I receive? This is the last thing you want to think about when you’re dealing with an urgent medical situation. So it’s good to know how insurance works at emergency rooms beforehand.
Know How Insurance Works for Emergency Room Visits
Fact 1: If you have a legitimate “emergency medical condition,” health insurance companies are required to cover ER services at in-network rates, even if the hospital is out-of-network. If an ER doesn’t accept a certain type of insurance, the ER is still required to treat you. You will be billed later for services.
Fact 2: When you have a medical emergency, don’t waste time trying to call your insurance company to get approval for treatment. You DO NOT need to get prior approval from your health insurance company.
Fact 3: Although a certain hospital takes your insurance, this doesn’t mean that you won’t get bills from out-of-network providers. Some emergency visits will entail the help of independent contractors and services, like anesthesiologists and lab work, which may not be in-network with your insurance plan. The best solution is to work with your insurance provider whenever you get a new plan to understand how ER coverage works. Make sure to ask your representative how additional services will be covered.
Fact 4: Under the Affordable Care Act, if you receive care from an emergency room, your co-pay or co-insurance cannot be higher than your in-network rate, even at out-of-network hospitals. But keep in mind that out-of-network providers can still bill you for the remaining balance after you’ve received care.
Hospitality Health ER in Galveston strives to make the billing and insurance process seamless. See here how our emergency room is making it easier on patients.