In the old days, most health insurance plans covered emergency service with a simple co-payment. Visits to the ER typically required a flat fee of between $50 and $150, with the remainder of the charges being picked up by the patient’s health insurance policy. And during this time, which was prior to the advent of Urgent Care facilities, the ER was where many people, typically those who did not have their own doctor, would go for minor ailments. In addition, many of these people did not have insurance and were not able to pay for their service.
The use of emergency rooms for routine care began to be quite costly for health insurers, as ERs designed to treat trauma were much more expensive to operate than a regular treatment setting. And because payment was often not collected, the ERs themselves began losing money as well.
In order to curb this abuse, many emergency departments have begun requiring payment for service up front, before administering care. In addition, health insurers have begun to revise their ER benefit, often charging a $150 copay in addition to requiring satisfaction of the policy deductible before payment of benefits kicks in. The goal is to direct patients who do not actually need emergency treatment to Urgent Care facilities, which are much less costly to operate.
It is therefore important to understand the ER benefit on your health insurance policy, and also consider whether or not to seek treatment there or in an Urgent Care facility. Otherwise, you could be in for an unwelcome surprise when the bills arrive.