[smartdoctor] Paying for Emergency Room Visits
- From: "bari sita" <bari.nikola.sita@xxxxxxxxx>
- To: <smartdoctor@xxxxxxxxxxxxx>
- Date: Sat, 4 Oct 2014 21:22:53 +0200
Emergency Rooms vs. Urgent Care: Differences in Services and Costs
Emergency medicine is divided into two parts. Pre-institutional care
includes the treatment of patients at the scene of an accident or emergency,
most often by first responders such as police, firefighters and emergency
room technicians (EMTs). It also includes ambulatory transportation to an
emergency care facility.
Institutional care is the part of the system that includes hospital
emergency departments (EDs), which provide initial treatment for a wide
variety of illnesses and injuries, some of which may be life threatening
and/or require immediate attention; and urgent care facilities, geared to
treating less serious ailments and non-life-threatening injuries.
Emergency Rooms
An emergency department, or emergency room (ER), is generally part of a
hospital or medical center. It specializes in the acute care of patients who
arrive without an appointment and is typically open 24 hours a day, 7 days a
week, 365 days a year.
According to the Centers for Disease Control and Prevention (CDC), Americans
made 136.1 million visits to one of the country's nearly 3,900 emergency
rooms in 2012. Approximately 20 million of them arrived by ambulance. About
43 percent of all hospital admissions originate in an emergency room.
Normally, emergency room patients receive one of five levels of care: Level
1 is for minor problems, such as an earache. Level 2 may be for a cut that
requires stitches, while level 5 is for more severe problems, like a broken
bone. Even higher levels of care exist for critically ill patients.
While the American College of Emergency Physicians reports that 92 percent
of emergency visits are from "very sick people who need care within 1 minute
to 2 hours," the National Hospital Ambulatory Medical Care Survey estimates
that one-third to one-half of all ER visits are for non-urgent care. In
fact, the top three reasons for ER visits in 2007 were for superficial
injuries and contusions, sprains and strains, and upper respiratory
infections. (The CDC defines non-urgent as "needing care in 2 to 24 hours.")
The main reason that so many emergency room visits are for non-urgent care
is that hospital EDs are required by federal law to provide care to all
patients, regardless of their ability to pay. Since they cannot be turned
away, patients without
<http://www.debt.org/medical/health-insurance-premiums/> health insurance,
or the necessary funds to pay out-of-pocket costs, often utilize emergency
rooms as their main health care provider. This puts ERs under tremendous
strain, and limits their ability to more quickly attend to health
emergencies <http://www.debt.org/advice/building-emergency-fund/> .
It is estimated that more than $18 billion could be saved annually if those
patients whose medical problems are considered "avoidable" or "non-urgent"
were to take advantage of primary or preventive health care and not rely on
ERs for their medical needs.
Struggling with Medical Bills?
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Emergency Room Costs
Emergency room costs are difficult to quantify and are most often unknown to
a patient when he or she walks, or is wheeled, in the door. Other than
knowing the standard co-pay amount for those who have private medical
insurance, which can be several hundred dollars, it is impossible to
determine how much the final ER bill will be until it is received in the
mail a few weeks after treatment.
ER costs correspond to the severity of a patient's illness or injury, the
number of diagnostic tests and/or treatments performed, physicians
<http://www.debt.org/medical/doctor-visit-costs/> ' fees (typically about
20-25 percent of the total charges), radiology or specialist services, and
any pharmacy or other hospital expenses. For example, an ambulance ride
alone can cost between $400 and $1,200, depending upon location, distance
from the hospital and services performed. Costs vary widely in different
parts of the country and ultimately depend upon who pays - the individual, a
private health insurer or a government agency like Medicare or Medicaid.
According to the Agency for Healthcare Research and Quality (AHRQ), average
expenses for all people who had one or more visits to an ER in 2009 were
$1,318. According to Kiplinger's Personal Finance magazine, in 2011 the
average in-network cost of an emergency room visit for someone with private
health insurance was about $933. An Annals of Internal Medicine study found
that the average 2009 cost of an ER visit for three common illnesses -
middle ear infection, pharyngitis and urinary tract infection - was $570.
The following estimated costs are for nine of the most common reasons people
visit the ER.
They were determined by calculating the average number on claims submitted
in 2010 to the Medica Choice Network, a system of more than 4,000 medical
offices, clinics and hospitals across four Midwestern states:
. Allergies: $345
. Acute bronchitis: $595
. Earache: $400
. Sore throat: $525
. Pink eye: $370
. Sinusitis: $617
. Strep throat: $531
. Upper respiratory infection: $486
. Urinary tract infection: $665
Urgent Care Centers
Urgent care centers are freestanding, walk-in medical facilities that
provide care on a no-appointment basis and are often open for extended
hours, including nights and weekends. Sometimes referred to a "doc in a
box," urgent care centers are a cost-effective alternative to emergency
rooms for the treatment of non-life-threatening medical situations such as
cuts, sprains, simple bone fractures, flus and fevers, insect bites,
infections, etc. Some centers provide basic laboratory and X-ray services,
and most can run diagnostic tests and dispense prescriptions.
These care centers have existed in the United States for more than 30 years,
and today there are approximately 8,800 facilities nationwide. They
accommodate an average of 342 patients a week.
Centers can be owned by doctors, hospitals or corporations and take in
approximately $13 billion in revenue annually. Many urgent care centers are
staffed by nurse practitioners and physician assistants, in addition to at
least one board-certified physician.
Urgent Care Center Costs
Urgent care costs are significantly less than those of ERs, but are also
difficult to quantify. The Annals of Internal Medicine study found that the
average cost of an urgent care visit for three common illnesses - middle ear
infection, pharyngitis and urinary tract infection - was $155. Other
estimates place the average urgent care visit at anywhere from $71 to $125.
The bottom line is that an urgent care visit is substantially cheaper than
an ER visit.
The following costs are from Medica Choice Network estimates for nine common
ailments treated at urgent care centers:
. Allergies: $97
. Acute bronchitis: $127
. Earache: $110
. Sore throat: $94
. Pink eye: $102
. Sinusitis: $112
. Strep throat: $111
. Upper respiratory infections: $111
. Urinary tract infections: $110
Paying for Emergency Room Visits
In addition to the expensive procedures, services and equipment offered at
the nation's ERs, one reason emergency room costs are so high is because of
the large amount of uncompensated care they deliver. According to the
Centers for Medicare & Medicaid Services (CMS), almost half of all emergency
services nationwide go uncompensated. So, the burden of paying for this
"free" care must be absorbed by the hospitals and their physicians, but also
by those who are privately insured and those who self-pay.
Another reason that ER bills are high is that for the most part, hospitals
never expect that they are going to be paid in full, either because patients
are too poor to pay or because prices have been negotiated beforehand by
private insurers or, in the case of Medicare and Medicaid, by the
government.
For example, while the uninsured are charged the highest rates - called
gross rates - an insured patient may tally $3,000 in charges. His or her
insurance company may pay only $1,500, based on an agreement with the
hospital.
How the cost of a typical gross emergency room bill gets dispersed:
. Private insurance: 54 percent
. Medicare: about 38 percent
. Medicaid: about 33 percent
. Uninsured patients: 35 percent
Sometimes an ER bill is so exorbitant that a patient is simply unable
<http://www.debt.org/medical/> to pay all or part of it. Therefore, it
always pays to bargain when it comes to paying an ER bill, even if the
patient is uninsured and has agreed to self-pay. Most hospitals will offer
discounts for self-paying individuals, especially if there is a risk that
they might not be paid at all. The same goes for the physician portion of
the bill.
Even insured patients, especially if they are willing to contest specific
charges, may get a reduction of their ER bill by contacting the hospital's
billing office. In addition, most hospitals will work with patients to
create some sort of payment plan that allows reimbursements over time. If
the bills are still too high, patients may consider settling their debt
through a professional <http://www.debt.org/settlement/> debt relief firm.
Even with its high costs, however, the percentage of the country's total
health care spending on emergency care is actually very small. According to
the Agency for Healthcare Research and Quality, in 2008, when the nation's
total health care expenditures was approximately $2.4 trillion, all services
provided in American EDs, including physician services, was $47.3 billion
-barely 2 percent of the overall amount.
Paying For Urgent Care Visits
Care at urgent care centers is paid for on a fee-for-service basis. They
usually accept most private health insurance plans, with co-pays averaging
between $25-$50. A self-paying individual will usually be asked to make a
down payment for the visit, with other charges billed at a later date. Cash
discounts are often offered for the uninsured.
In any instance where medical debt becomes unmanageable, or is charged-off
to a debt collection agency, an individual can work with a reputable debt
relief company, experienced in debt settlement and/or debt consolidation. A
financial professional can create a plan to help reduce the debt's principal
amount or allow the debtor to consolidate several debts into one manageable
payment, potentially with a lower interest rate.
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