Pop quiz: What’s the #1 reason for visiting an emergency room near you while on vacation?
You may have thought injury—from snowboarding to scuba diving and everything in between, there are a lot of ways to get injured while on vacation. But you’d be wrong.
You may have thought illness—allergic reactions to new foods or being introduced to new germs happens all the time. But that’s still not it.
The #1 reason for visiting an emergency room near you while on vacation is alcohol consumption. The most recent data available through drugabuse.gov reveals that there were 3.8 million ER visits related to alcohol use in 2010. That is up more than 50% from 2001 when ER visits related to alcohol use totaled 2.4 million.
That goes to show that even the most tame vacations can wind up going south if you aren’t careful.
But going to the ER on vacation is scary because of two words: balance billing. When your insurance refuses to pay because you were “out of network,” you’re left with a crushing ER bill.
1. Call Your Insurance Before You Go
Contact your insurance provider before you go on vacation to ask about their policies and charges for out-of-network ER visits. You may to get details and understand the cost of doing “just one more” round of drinks with your friends and family.
2. Find a Freestanding Emergency Room
When you’re in an emergency, you need to be seen fast. But the CDC reports that the average wait time in a hospital ER is 30 minutes, and treatment time is 90 minutes, totaling 2 hours for your ER visit.
Rather than spending your vacation time on hard chairs that smell like antiseptic cleaner, you can get in to see a doctor sooner at a freestanding emergency room. There is no difference in cost or quality of treatment. The only difference between hospitals and a freestanding emergency room is that in a hospital you wait, and in the a freestanding ER you get seen immediately and get treated with care and respect.
3. Know Your Rights
According to provisions in the Affordable Care Act (Obamacare), your out-of-network visit cannot be billed the way it used to. Insurers are required to pay an amount equal to the greatest of:
- The median amount health insurers pay in-network providers for emergency services furnished;
- An amount based on the same methods used by health insurers generally used to pay for out-of-network services (eg, usual and customary amounts); or
- The amount Medicare would pay for emergency services provided.*
Healthcare.gov also explains what you should do when you are in an emergency, and what you should watch out for with billing:
- In a true emergency, go straight to the hospital. Insurers can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.
- Insurance plans can’t make you pay more in copayments or coinsurance if you get emergency care from an out-of-network hospital. They also can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.
4. Investigate a Balance Bill
If you receive a balance bill that does not comply with the guidelines from Healthcare.gov, you have a few options.
First, call the facility where you received care. Billing errors happen, and most facilities are happy to remove or revise any mistaken charges.
Second, you can contact your insurance provider. They may have made a mistake, or they may be willing to recognize that they did not bill you accurately.
Third, you can appeal your balance bill to the Texas Department of Insurance (TDI). A recent review of complaints submitted to TDI revealed that patients with balance bills are over-charged an average of $1,096. TDI does not guarantee any percentage or dollar amount as each case is unique.
Have Questions? Call Emergis ER.
If you have any questions about care that you received at Emergis ER, or if you are planning ahead, call Emergis ER any time day or night to get answers to your questions. When you’re in an emergency, you need peace of mind. Emergis ER is here to help you when you need us—we just hope you never need us.
Have a fun and safe Spring Break this year!
*By law, Emergis ER is not permitted to bill to government-funded healthcare programs, including Medicare, Medicaid, and Tricare. If you are on one of the programs, you are welcome to come in, and your visit will be billed as an individual payer.