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Determining the Average Emergency Room Cost

September 26, 2023

Determining the Average Emergency Room Cost

Emergency room (ER) visits are not something anyone plans for, but they are an inevitable fact of life. Whether you're suffering from a serious illness or have been in an accident, there are situations where you need emergency care. While these visits are vital for your health and well-being, they can also come with a hefty price tag if you're uninsured or the reason for your visit isn't covered. That's why it's essential to understand the average price of emergency room visits. You might be surprised how much they can vary depending on your insurance plan and what condition you're there to treat, but there are ways to protect yourself from high medical bills. Check out our guide below to learn what you can expect with regard to the emergency room cost when you are in a life-threatening situation.

What is the average cost of an emergency room visit?

According to most sources, the average cost of an emergency room visit in the United States is around $2,200, but this number can vary depending on a variety of factors, including the severity of the condition, where you live, and what type of insurance plan you have. For example, if you have health insurance through the Affordable Care Act (ACA), your out-of-pocket expenses will be capped. But, even with insurance, you may still end up paying several hundred dollars or more for an ER visit.

The ACA sets a number of limits on the out-of-pocket costs that individuals can be charged for healthcare services, including emergency room visits. However, this does not mean that you will have no cost for these services; it is likely that you may still need to pay copays, coinsurance, or deductibles in addition to what your insurance covers. Additionally, insurers are only required to provide coverage up until a patient's condition becomes stable—any other treatment costs could be on the consumer themselves if they choose an out-of-network provider or hospital.

To reduce the emergency room cost of a visit, you need to understand what kinds of conditions require this level of care. If you can avoid going to the ER for minor issues such as a cold or fever, you may be able to prevent a costly medical bill altogether. Furthermore, if you don’t have health insurance, many hospitals offer payment options like charity care and financial assistance programs to help people manage their medical bills.

Will your health insurance cover the emergency room cost?

It's a common worry for many people—what happens if you suddenly need to go to the emergency room? Will your health insurance cover the cost? Since 2010, the ACA requires insurance companies to cover the care you receive in the ER if you have an emergency medical condition. One of the key provisions of the ACA is that it requires insurance companies to cover emergency medical care for those that have an emergency medical condition regardless. This provision ensures individuals who experience sudden and unexpected medical emergencies will receive the care they need without worrying about the high cost of emergency room visits.

The ACA defines an emergency medical condition as a medical condition that manifests itself in such a way that a reasonable person would believe that the absence or the delay of emergency medical care could result in some type of serious harm or even death. It's crucial to note that the ACA does not require insurance companies to cover non-emergency care in the ER. If you go to the ER for a non-emergency condition such as a headache, flu, or minor injuries, your insurance company may not cover the cost of your visit. Take advantage of resources like our learning center at HealthInsurance.com to educate yourself on your plan.

When should you go to the emergency room?

EMTs load a patient into the back of an emergency vehicle for transport.
 

Knowing when to go to the emergency room can be challenging for many individuals, particularly if your goal is to avoid paying a high emergency room cost for a visit that your insurance company deems unnecessary. While some medical emergencies are obvious, others may not be so clear-cut. In general, the emergency room is for medical emergencies that require immediate attention. Conditions that pose an imminent threat to the patient's life or health should be treated as emergencies. Some situations that warrant a visit to the nearest emergency room include:

  • Chest Pain
  • Difficulty Breathing
  • Severe Abdominal Pain
  • Head Injury
  • Loss of Consciousness
  • Allergic Reaction
  • Heart Attack or Stroke Symptoms

Not all conditions require a trip to the ER and you do have some other options to consider when you're experiencing a medical issue. For non-life-threatening conditions, a visit to a primary care physician or urgent care center may be more appropriate. Patients with minor injuries, minor illnesses, or conditions that can wait until the next day or two should consider seeking non-emergency care. As a general rule, if you're in doubt or cannot handle the situation at home, seek emergency care or call 911. It is always better to be safe than sorry when it comes to your health.

The cost of an emergency room visit can vary greatly, depending on the hospital you go to, the level of treatment you require, and your insurance coverage. Knowledge of ER costs can help you make informed decisions when choosing an insurance plan. Some plans may have higher premiums but lower out-of-pocket expenses, while others may have lower premiums and higher costs when you need to use them. By researching the emergency room cost of visits, you'll be able to find a health insurance plan that fits your needs and budget. When you're ready to start learning about your options so you can get the insurance coverage you need, you can visit HealthInsurance.com to compare plans.



 

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