There is an ongoing drive to send patients to urgent care clinics or your doctor’s office rather than then emergency room. It can save both you and your insurance company money. There are exceptions to the rule of course, if you are referred to the emergency department by your doctor for an x-ray or other non-emergency services. The exceptions also include situations where the nearest clinic is too far away, it is the weekend or if you are bringing your child. When an actual emergency happens very few consider whether they are covered they are more concerned with getting to the doctor. But the question remains, are you insured for an emergency?
Going to the ER
There is a lot of grey area when it comes to defining what an emergency is. The ACA defines it as “a prudent layperson, possessing an average knowledge of medicine and health”. That doesn’t help much, since you need to see a doctor first before they can determine if this is a real emergency or not. You as the patient or parent of a patient has to decide if your illness is worth an ER visit and whether you can afford it. Here are some situations where your visit may not be covered.
A Genuine Emergency
There are times that are genuine emergencies such as accidents or coronary events and you need to get to the ER now. But if you ever look around the waiting room of an ER there are plenty of people there with headaches, colds and sore throats which can be treated at a clinic or at a pharmacy. If you are unsure, then before you head to the ER let’s look at some alternative options.
- Try a virtual doctor, you can speak with a healthcare professional online and determine if you need the ER or not. This is a new tool for the healthcare industry and lots of insurance companies will cover this option for you.
- Visit a nurse at a drug store, many of them will be open for consultations outside of business hours to see you.
- Use a Medical Cost Sharing program, often these are organized through your church where the participants support each other’s costs.
Read the Fine Print
Always read your insurance policy to understand what and how emergency care is covered. You need to understand how your insurance company defines an emergency and what they are going to cover. The cost of healthcare is rising, with less coverage and higher out of pocket expenses and the onus is on you to understand your policy.
If the emergency is not one that is covered and you have a bill from the ER then check with the hospital to see if you meet the guidelines for financial assistance. Don’t make the mistake of assuming these programs are just for the uninsured or low income families. There are programs for patients that have their own insurance so check to see if you qualify.