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Are You an Inpatient When You Are In the ER?

High angle view of doctor defibrillating male patient while nursNo. One of our readers, Bob, was very surprised with this answer. Bob was taken to the ER after a car accident. He was treated and released. Following his ER visit, Bob got many bills saying he had to pay for much of the cost himself. He wondered why since he had good hospital insurance coverage.

I explained to Bob that insurance companies consider the ER an outpatient service. Your insurance often covers less of the cost of outpatient services than inpatient services. This is confusing since the ER is usually in the hospital.

Additionally, there are often many people who see you in the ER who will each likely send you a separate bill. The ER physician may send you a bill. You may get a bill from the radiologist who read your x-ray. You will also get a bill from the hospital for all the services you received in the ER. Since these are all outpatient services, you will likely have to pay for many of the costs out-of-pocket.

The average cost of an ER visit is approximately $1,265. It can cost a lot more depending on the seriousness of the visit and which tests are run.

If you are admitted to the hospital, the ER charges are often included in the hospital bill. However, if you are like Bob and you are sent home, you may be responsible for a large part of the bill.

Do you have any questions about your health insurance coverage? I’d love to hear from you!

MyHealthSpin helps you Spin Your Healthcare Your Way!

Check out how more information on insurance in our new book, Easy Healthcare: Choose Your Health Insurance.

 

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How Can I Avoid ER “Observation?”

daughter hugging her fatherThis is a question Laura asked me this week. The answer is “talk to the ER doctor.”  

Laura explained to me that her dad wasn’t feeling well last month so she took him to the ER. The hospital held Laura’s Dad in the ER for several days. The room Laura’s Dad was in looked like a normal hospital room and she thought he was admitted to the hospital. However, as it turns out, he was actually in “observation.”

Observation means the physician is trying to decide whether the patient needs to be admitted to the hospital or can go home. The only way to know whether Laura’s dad was “admitted” or in “observation” was to ask. The hospital is not required to tell the patient that they are in observation. Medicare recommends that “observation” be limited to 24-48 hours, however, some hospitals keep patients in “observation” for much longer.

Laura and her dad found out why “observation” can be a problem. Laura’s Dad was referred to a rehabilitation facility upon leaving the ER. For many services like inpatient rehabilitation, you must have been admitted to the hospital for a certain period of time for your insurance to cover the service. Many insurance plans only cover rehabilitation facilities after a certain amount of time as an inpatient in the hospital. For example, you might need to be in the hospital for 3 days prior to being admitted to an inpatient rehabilitation facility for your insurance to cover the rehabilitation costs. If you were in “observation” for 3 days, that will not meet the requirements by your insurance company.

How do you avoid this problem?

  1. Talk to your doctor and ask whether you are admitted or in observation.
  2. If you think you must go from the ER to another care facility, ask the hospital whether it is necessary to be admitted into the hospital to get coverage.
  3. If you find out you are in observation, insist on being admitted if it is necessary to stay in the hospital.

Have you ever been placed in “observation” in the ER? How long did it last? I’d love to hear from you!

MyHealthSpin helps you Spin Your Healthcare Your Way!

Check out how more information on insurance in our new book, Easy Healthcare: Choose Your Health Insurance.

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5 Dos and Don’ts of Using the ER

Emergency Sign With Copy SpaceCall any doctor’s office and you’re likely to hear a message like this: “If you are getting this message and need medical attention, call 911 and go to the nearest ER.” Should you follow this advice? Not always.

The ER can be very expensive, time consuming and not always the best place to go for basic medical care.

There are some basic Dos and Don’ts when it comes to the ER.

DO go to the ER when:

  1. You have a life threatening problem, such as a heart attack, stroke, etc.
  2. You were in a serious accident.
  3. You are unconscious.
  4. You are bleeding heavily or are in excessive pain.
  5. You have been directed to do so by your doctor.

It is important to understand that the ER is intended to take care of severely sick people. The hospital will determine who in the ER is the sickest and take those people first. So if you go to the ER for basic medical care you will likely be waiting a long time. Often you will wait only to be seen and told to go to your own doctor the next day. If this happens, you have paid a lot of money for an expensive ER visit when you could have just waited until your doctor opened in the morning. 

So when should you skip the ER?

DON’T go to the ER when:

  1. You have a basic cold or virus.
  2. You need to see a specialist, but it is not urgent.
  3. You need to see your doctor – it’s not likely your doctor will come to the ER.
  4. You need to get a test which is not urgent.
  5. You can wait until your doctor’s office opens in the morning.

Have you ever gone to the ER and wished later that you had not? I’d love to hear from you!

MyHealthSpin helps you Spin Your Healthcare Your Way!

Check out how more information on insurance in our new book, Easy Healthcare: Choose Your Health Insurance.