I had to go to the emgerency room on on 2/14/08 bc I didn't have a regular doctor!!!?

Question

They are trying to charge me $812 dollars to find out that I had a sore throat...I haven't met my deductible yet this year, so it saying basically my insurance isn't gonna cover nothing. What is going on shouldnt my insurance have to pay some part of this. what should I do??? This bill is way to high

Answer 1

Actually, $812 is not high for an ER visit.  You made a choice to go to the ER for a non-emergency situation.  Now, unfortunately, you're learning an expensive lesson - the ER is the most expensive alternative and should be reserved for true emergencies.

I'd advise you to establish a regular physician for future illnesses.  But you should also be aware of what urgent care centers in your area participate with your insurance - if you don't have a regular physician and/or if a person's regular doctor isn't available, an urgent care center would be the more appropriate place to go for a sore throat than an ER.

Frankly,  you're lucky if your insurer is giving you credit for that $812 towards your deductible.  That means your visit is still covered - just applying towards your deductible.  Most insurers would consider an ER visit for a sore throat to be completely not covered at all - which means that you'd get stuck paying the bill *and* it wouldn't count towards your deductible.

Answer 2

u get a doc. yet?

Answer 3

Sounds like the $812 IS your deductible. Call your insurance. Ask the hospital for an itemized bill if you're concerned with the amount they charged.

Answer 4

Did you get a bill from the ER stating that your insurance was not covering it? Did you get an explanation from you insurance that they were not going to pay anything due to it not being an emergency? Seems like there has not been enough time for any of that to have occured yet. Check with your insurance first. Wait until you get their explanation of benefits. If they apply it all to the deductible, the amount you owe should be at a reduced "contracted" rate-not the amount that the ER actually charged, and it should be alot less than that!

If you find that the bill is still too high, contact the billing dept and see if they can offer any financial assistance.

Lesson learned here-Feb 14th was a Thursday (If my memory serves!) and going to a clinic or urgent care would have been a much more appropriate way to go. They are open later-usually until 9PM or so...Hopefully, you have a "regular" doctor by now, so this can all be avoided in the future!

Answer 5

Insurance does not cover anything if the total of everything is less than the deductible.  Most insurance does not cover going to the emergency room for anything other than an emergency.  (They would not consider a sore throat an emergency under any circumstances.  However, state law may require them to treat all chest pain that feels like a heart attack as an emergency, even if it is later determined to be something trivial.)

There are lots of immediate treatment places that will see someone who does not have a regular doctor and charge less than an emergency room.

You can try to negotiate with the hospital for a reduction, but you are going to have to pay something, and more than you would have paid if you had gone somewhere other than an emergency room, and the insurance will not pay anything.

Answer 6

Most insurance companies will only pay an emergency room visit if you are admitted to the hospital. Otherwise, you're on your own.

Now you see why it's so important to have a regular physician. You could have taken up space for someone who was in dire need of emergency services.

Answer 7

Sounds like an expensive lesson, lets hope you learned from it and now have a "regular doctor", especially since it doesn't cost anything to get one.

Answer 8

If your insurance was billed, and they put the whole thing to your deductible, you have no choice but to make payments. Asking for a reduction in fees AFTER a claim has been processed is a big no-no. And a good many places won't do it. They've been told in writing that they're entitled to it, so they're going to get it. Besides, you potentially took a doctor's time away from a true emergency - like someone having a heart attack - that brings in big bucks, so suck it up. Make a payment plan.

The other reality is, you went to the emergency room for something that is not generally considered an emergency. Therefore, the insurance doesn't have to pay anything. (If you were bleeding profusely or couldn't breathe, THAT is an emergency. A sore throat is not.)  That is why there's often such a wait in the ERs and part of the reason why the cost of medical care is so high.

Answer 9

Insurance companies will only pay for emergency room visits if it was a "true" emergency.

1.10  'Emergency medical condition' means a medical or behavioral condition, the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in: (a) placing the health of the person afflicted with such condition in serious jeopardy, or in the case of a behavioral condition, placing the health of the person or others in serious jeopardy; or (b) serious impairment to such person's bodily functions; or (c) serious dysfunction of any bodily organ or part of such person; or (iv) serious disfigurement of such person."

If you had gone to a regular dr for your sore throat, your cost of care would be far less.

Answer 10

Next time something like that arises, find an urgent care clinic (check your insurer's provider directory).  The ER is the last place you should go unless it is truly an emergency.

Answer 11

call the billing/financial department and explain yourself-demand a lower CASH paying rate...you are responsible for all $$ under the deductible-screwy, I know.

THEN, ask to make payments