A Doctor’s Frank Discussion on ER Charges


Emergency department (ED) bills are controversial, in part, because it feels like a monopoly. People need care, they report to the one place available to get it, and families rack up bills that they can’t pay.

Things aren’t as the public assumes. EDs aren’t charging so much just because “they can.” Here is why, in my professional opinion, emergency departments have to charge as much as they do for the services they provide:

How Emergency Departments Charge Patients

There is not a whole lot of difference between the ED charges at a hospital-based ED vs. a freestanding emergency department (FSED). Having had two members of my family in the ED in the not too distant past, I can personally attest to this. The facility charges for the FSED are not that much different from the hospital-based ED.

At our Emergis facilities, patients are given a medical screening exam (MSE). If an emergent condition is found, it is recommended that they proceed with evaluation and treatment either with us or another facility if they choose. If no emergent condition is found, they are given the option to proceed with full disclosure of what their charges are estimated to be, or to forgo treatment and leave the facility at no cost to them. We don’t get paid for the MSE, but we are still financially on the hook to pay our providers for this free service.

The State of Texas does not allow an FSED to charge a facility fee for Medicare or Medicaid. When given the results of their MSE and financial options to Medicare/Medicaid patients, many of these patients opt to go to a hospital-based ED where their government assistance will cover them. It is no secret that hospitals and EDs struggle with low reimbursements, or the inability to collect from patients who misuse the ED and facilities can rack up tens and sometimes hundreds of thousands of dollars in uncollected medical fees, which increases the healthcare costs for everyone.

The Public’s Responsibility for Emergency Department Charges

Here is where nobody in the public health arena seems willing to address the elephant in the room: Emergency department services are abused by many who either lack the understanding of what constitutes a healthcare emergency or have a decreased sense of responsibility for the cost of emergency department services and the impact it has on public healthcare costs.

Recently in a local hospital (Dallas, TX, area), it was reported that a young woman showed up at the ED—via an ambulance, no less—because she was getting a manicure and the manicurist caused her cuticle to bleed. She was reportedly discharged from the EMS gurney in the ED, allowing the ambulance to return to service.

Each week in the emergency department I see numerous patients who have insect bites. They are not infected insect bites—just insect bites. We see patients who have an appointment set up with their primary care provider for “this afternoon” but just didn’t want to wait because they were coughing a little worse. Mothers bring their children in due to vomiting “one time this morning.” We have an endless list of patients who have monthly and often weekly visits to the ED, sometimes for questionable purposes.  We take each patient’s concern seriously and do all that we can to appropriately evaluate and treat these patients, many of whom could have been appropriately treated by their primary care physician or an urgent care clinic, if they required outside medical intervention at all.

When we, as physicians, try to counsel these patients with regard to appropriate use of the ED and what is more appropriate for an urgent care facility or their primary care provider, a common answer we get back is “Well, It’s an emergency to me!” with a subsequent lambasting of the physician on the Press Ganey scores. Some of these patients are the same patients who will later dispute their bills, stating, “I didn’t know that it was an emergency department.”

Contrary to some reports, these FSEDs are not taking business away from the hospital-based EDs. I have never seen it busier in the hospitals than I have over this past year. The public will use what is available and convenient to them.

Our Focus Is Health

Working in trauma units and emergency rooms is a tough job. That’s why I’m convinced that people can’t have this kind of job if they are motivated by anything other than helping you get better.

If you or a loved one has a medical emergency, don’t hesitate to visit us. You can also call us 24/7 and speak directly to a licensed professional about your situation. When you come in, you will get a free medical screening; if your condition doesn’t require emergency care—and the associated charges—we’ll tell you, and you can go to another care provider without any charge from us.

We hope you never have an emergency. But when you do, we’re here to help you get better faster.

jsteadmansAbout the Author:

Dr. Jon Steadman is a board certified emergency medicine trained physician and the chief medical officer for Emergis ER. You can find Dr. Steadman using his expertise from working at many different emergency room settings within the Dallas area as well as Oklahoma and Mississippi to bring a high level of clinical excellence and patient satisfaction to Emergis ER.