The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 Show
www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. In the United States, an emergency room visit costs $2,200 on average, according to the most prominent insurance carrier in the U.S., UnitedHealthcare. Sometimes, a visit to the emergency room can exceed these prices since the actual price you pay out of pocket will depend on your condition and the diagnostic tests and treatments you undergo. A few things to know about how emergency departments determine how much to charge you:
It is essential to determine if your condition is genuinely emergent or could be treated at urgent care. Mira could help you access affordable urgent care, virtual care services, discounted prescriptions, and more starting at just $25 per month. Learn more. Average ER Costs Based on The Types of TreatmentThe price of your ER visit will depend on what types of treatments and medications you receive. For patients without health insurance, an emergency room visit can cost less than $2200. If your treatment is extensive, an ER visit can exceed this price. For instance, in some cases, especially where critical care is required and/or a procedure or surgery is performed, the cost could reach $20,000 or more. Average Cost of Common Conditions Treated
Average Cost of Common Services
Below is the average price for an ER visit in each state, from lowest to highest. This is the out-of-pocket cost with no health insurance coverage and for a moderate to a severe ER visit. Average ER Visit Cost by State
Common Reasons For Visiting the ER & Avoidable VisitsPeople visit the emergency room for various reasons that can be classified according to different levels of care. Outlined below are some of the most common reasons for visiting the ER. According to research done by NY state, 25 conditions are most common for ER visits. Notice that many visits are non-emergent, primary care treatable, or emergent but avoidable. In another research, the state found that more than half of the total 7 million ER visits in 2018 could be treated elsewhere.
Please note that this list is not comprehensive. Understanding the Emergency Severity Index (ESI) ScaleTypically, emergency room patients receive one of five levels of care. Level 5 care represents minor problems treated, whereas level 1 care represents some of the most severe treatments an ER can provide. (hence we commonly call an academic medical center a level 1 trauma center). While levels of care exist for even higher and critically ill patients, these levels are used less frequently. Get Mira - Health Benefits You Can Afford.Get doctor visits, lab tests, prescription, and more. Affordable copays. Available in 45+ states. Only $45/month on average. Emergency Room Care Costs by Levels
Insurance Coverage for ER VisitsThe Affordable Care Act (also known as Obamacare) requires all plans to cover emergency services. Under this legislation, insurers cannot charge you more for going to an out-of-network hospital or health care provider. In addition, insurers cannot require you to get pre-authorization before getting service. Health insurance plans are typically offered in the following categories: Bronze, Silver, Gold, and Platinum. Each plan will provide varied coverage for healthcare bills. Coverage Percent by ACA Plan Type
Catastrophic health insurance coverage is also available for individuals under 30 or individuals of any age with a hardship exemption or affordability exemption (based on Marketplace or job-based insurance being unaffordable). Catastrophic health insurance is a type of health plan that offers coverage in emergencies and coverage for preventive care. Factors that Contribute to ER BillsSeveral factors determine the high costs of ER visits. No sole factor is singularly responsible for the price of an ER visit. Rather, the intermingling of each of these factors contributes to the high costs of an ER visit. Costs are Determined Based on the Facility and LocationEvery emergency room has various costs for supplies and employees depending on:
Insurance CoverageInsurance status and categories greatly influence how much the patient has to pay out-of-pocket. For instance, health insurance plans with low monthly premiums may have a cap of around $250 on emergency room expenses. With ER costs ranging from $150-$3000, less extensive insurance plans may only cover the most basic ER visits. In addition, patients should also note the “in-network” or “out of network” emergency rooms with your insurance plan. Out-of-network ERs will not be covered by your insurance plan and will undoubtedly cost more than in-network ERs. You should also note that sometimes there are “out of network” doctors working in facilities that are “in-network,” which you might only find out once you get the bill. Virtual care for only $25 per visitVirtual primary care, urgent care, and behavioral health visits are only $25 with a Mira membership. Lack of Price TransparencyEmergency rooms do not provide pricing for services upfront. When you seek care in an emergency room, the medical staff will determine your best care plan. Regardless of the services you are provided (stitches, MRI, prescription medication, etc.), it is likely that you will not know the exact cost of services until after your visit. Running an Emergency Room is Very ExpensiveFrom minor cuts and bruises to MRIs and surgeries, emergencies handle all sorts of medical ailments. Keeping an emergency room open 24/7 with trained and skilled staff has very high costs. Emergency rooms have to pay for utility bills such as electricity, water, food, supplies, and medical care. These costs then get passed to the patients. Alternatives to the Emergency RoomIf you are experiencing a medical emergency that requires immediate attention, you should always seek care from an emergency room. However, urgent care may be a better alternative if your situation is not severe and does not demand immediate medical attention. Determining whether to go to urgent care or an emergency room can be unclear. Below are a few medical issues that urgent care clinics can treat:
Although going to urgent care is cheaper than the ER, true medical emergencies should always be tended to in an emergency room. How to Reduce or Dispute an ER BillMultiple factors contribute to the costs of surprise medical bills. Among these factors, the two most common reasons surprise bills exist are claim denials and out-of-network providers. Receiving a surprise medical bill can be scary, but you don’t always have to pay for them in its entirety. In 2022, the federal government passed the No Surprises Act (NSA) to improve healthcare cost transparency, which will help reduce the uncertainty that comes with medical bills. Bottom LineAs you can see, a trip to the emergency room can vary in costs by what you’re going for and how long you end up staying. Plus, if you have health insurance with a deductible that isn’t met or insurance that won’t cover certain costs, then what you’re actually paying can get very complicated. An easier solution for many things people go to an ER for is Mira, where you can be seen by a local urgent care doctor today for as little as $45 per month and $99 per visit. Learn more about how Mira can simplify your health coverage. |