Emergency Room Insurance Coverage

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Margaret Huntley 30-07-2021

Does Health Insurance Cover Emergency Room?

Emergency Room Insurance Coverage - ConsumerCoverage

As the name implies, Emergency Rooms (ERs) are for emergencies. They do not require an appointment, and offer life-saving treatments. You may transport yourself to the emergency room, or you may require transportation services such as an ambulance ride. 

The most common definition of an emergency that requires a trip to the ER, is a life-threatening illness or injury, or an injury that could result in the loss of a limb without immediate medical attention. 

The ER is equipped to handle such emergencies with a wide range of medications, advanced diagnostic equipment, and specialist physicians. Though they can easily treat the most minor ailment, they should be reserved for emergency treatment. Besides, the emergency room costs more for minor ailments than a regular doctor visit would cost you. 

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Does Insurance Cover Emergency Room Care?

Yes. Under the Affordable Care Act (Obamacare), all health insurance plans are required to cover emergency room care. They are also not permitted to charge higher co-pays or coinsurance for out-of-network facilities. 

While all health insurance providers do cover trips to the ER, that doesn’t mean that it is completely free for you. You are still going to be paying out of pocket for:

  • Co-pays and Co-insurance: these types of policies require you to pay a percentage of the cost of your healthcare. So, if you require $5 000 worth of care, and your policy states that your co-pay is 10%, then you will be paying $500 out of pocket.  
  • Deductibles: You must pay your deductible before your insurance agency will cover your medical bills. Your deductible will vary depending on the type of plan that you have. 
  • Non-Essentials: Different insurance plans have different definitions of what constitutes an emergency, so be sure to check your plan for their definition. As well, your policy may only pay for your ER care up until your health is stable, meaning that any care received after that point will be at a cost to you. In such cases, out-of-network care will result in higher medical bills. You should also note that if your insurance company does not think that certain expenses (like an ambulance ride) were necessary, they will not cover the cost of it. 
  • Negotiated Rates: Many hospitals and insurance companies have a negotiated rate, which is an agreed upon sum of how much the insurer will pay the hospital for certain services provided to you. If your care exceeds this rate, you may end up paying out of pocket. 

In short, the amount of coverage that you receive for ER services will vary depending on your situation and the costs associated with your care. It is always a good idea to have extra savings just in case of such emergencies. It is also a good idea to know your health insurance policy inside and out, so that you know exactly how much your plan will cover in the event of an emergency. 

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Urgent Care vs. Emergency Rooms

Urgent care centres may be a viable alternative to emergency room visits. Like the ER, urgent care facilities do not require an appointment, and they can provide faster services for a significantly lower cost. 

They are not a substitute for life threatening emergencies, and they do not have the same amount of resources as the ER, but they can help in a lot of situations, such as:

  • Broken bones 
  • Bad cold or flu
  • Cuts that require stitches 
  • Abdominal pain
  • Fever without a rash

If you are in a more life-threatening situation than you realized, then the urgent care centre will send you to the ER for proper care. Check your insurance policy first to see if they cover the cost of urgent care centres, but definitely keep them in mind as a good alternative to having to endure a long ER visit. 

Regardless, the good news is that insurers will provide emergency room insurance coverage, and while your carrier may not cover all ER expenses, you shouldn’t be left paying completely out-of-pocket. 

Margaret HuntleyMargaret Huntley is a creative writing and philosophy student at Western University. She has been working as a freelance writer for over two years and has written about everything from insurance, to poker, to health and wellness for international businesses.