Thursday, December 8, 2016

The Cost of Emergency Medical Care, a new catch with insurance

My second job after college was working for an HMO.  I worked for the PPO provider side of that organization and it compelled me to understand health care.  Though I only worked for that business a short time, less than a year, I have been thankful for the education I had to gain by working there ever since.

Last month, my husband had to visit an emergency room out of the health care network of our current insurance plan.  We waited after he came home for the EOB (Explanation of Benefits) statement to arrive from our insurance.  Two weeks later, we received the good news that there was emergency hospital coverage--because the reality is that even though the papers I had said it would be covered, you just never know what loophole an insurance company might find.  So, we would just need to pay our emergency room co-pay.

When I saw the bill, it was what I thought it would be--around a thousand dollars, even though my husband had no x-rays or lab work done and was in and out of there in less than an hour.  Of course the insurance has a negotiated fee schedule, so they didn't have to pay that amount, but it was what the hospital billed.

Since I hadn't received the bill yet, I called the hospital today to find out if it was coming.  It is.  But, I learned that there would also be a bill from the ER Doctor.  Really?  This was new news to me.  We haven't made a visit to the ER in several years, so I assumed that the ER worked the same way as Urgent Care--one bill.  I was wrong.

Nowadays a trip to the Emergency Room involves both a hospital fee and a separate charge by the doctor.  I called the doctor's billing company and found out the exorbitant fee that the ER doctor charged.  My blood pressure ascended momentarily in a huge way.  Then I went to check my insurance.  They didn't deny the claim and we only owe a specialist's copay.

Wow.  My mind started spinning.  I was and am extremely thankful for the Lord's provision.  But, at the very same time, it made me think about how broken our insurance system is.  The hospital and doctor charged almost two thousand dollars for a visit that lasted less than an hour and that involved no xrays, an IV, or lab work.  What happens when people don't have insurance?  What happens when parents have a sick child who needs to go to the ER?  What happens when people have these high deductible plans--which are the most affordable ones (often the only affordable ones) through ObamaCare?   Prior to ObamaCare, the ER co-pay covered the whole visit.  There were many things that worked differently with insurance before ObamaCare's existence.

Insurance isn't something just to have for a rainy day anymore.  I wanted to share this story so that if you need to go to the ER, you're prepared.  The Urgent Care really is a much more affordable option... at this point.

1 comment:

  1. We have had to visit the ER several times for staples, stitches and broken bones. Be ware that not only does the ER and the doctor send a bill, but any labs, imagery, or other specialists will also be sending their bills. And our insurance has never paid them. We pay our co-pay and a large portion of the other bills as well. You must have great insurance. Ours is the best plan our employer offers, but we pay thousands in premiums and usually about 3000 more throughout the year in bills (for 8 of us).