A trip to the emergency room is always stressful. You or someone you care about is in physical pain, and everyone else is experiencing emotional strain. It’s a bad situation all around.
But the cost of the ER makes that bad situation even worse. Even with health insurance, you’re likely to have a copay of $50 to $300 for the visit. And without it, an ER visit could easily cost $1,000 or more.
The expenses associated with an ER trip can affect your life long after the injury or illness has passed. You can’t avoid these costs completely, but there are ways to keep them under control.
Ways to Save Money at the Emergency Room (ER)
Keeping your ER expenses low can start long before anyone gets hurt. A little planning can mean a lot of savings in an emergency. You can also help avoid a big bill by paying attention during the visit and advocating for your rights and financial health.
Just take these steps to keep emergency medical costs down.
1. Research Local Hospital Prices
Prices for hospital services are far from standardized. Two hospitals in the same town could charge significantly different prices to treat the same injury or acute illness. And choosing the cheaper one could make a big difference in your bill.
A regulation passed in 2019 requires all hospitals that use Medicare to provide a price list online. You can find this list by going to a local hospital’s website and searching for “standard charges.”
However, it may take some searching to find the exact cost for a specific procedure. During a medical emergency, you can’t afford to waste precious minutes checking prices at just one hospital, let alone comparing them across all your local hospitals.
Instead, try to get a general sense of the prices of different categories of care ahead of time. To do so, identify all hospital emergency rooms and urgent care centers within driving distance of your home.
Visit each one’s website and check its standard charges for different emergency procedures for someone with your insurance plan. For instance, you can check the price for setting a broken bone or treating a suspected heart attack.
Based on your findings, make a list of which treatment center has the best prices for each type of emergency procedure. Keep this list in your car so you’ll know which hospital to head for when an emergency arises.
2. Have an Emergency Fund
One problem with trips to the emergency room is that they’re an unexpected expense. You never know when they’re going to happen or what they’re going to cost. That makes it hard to budget for them.
One way around this problem is to create an emergency fund. You can start one by setting aside $50 to $100 each month until you have $1,000 to $2,000 in reserve. That money can help you pay hospital bills upfront rather than relying on credit cards or payment plans.
3. Set Up a Health Savings Account
If you have a high-deductible health plan, you can easily end up paying the whole cost for an ER visit out of pocket. But if you also have a health savings account (HSA), you can pay the bill with pretax dollars. And any money you withdraw is untaxed too.
An HSA is an even better way to save for medical expenses than an emergency fund, though you should have both since you can only use HSA funds for health care.
But these plans aren’t available to everyone. You must have a high-deductible plan to open one. And you must keep records of all medical costs funded with the HSA for tax purposes.
4. Fine-Tune Your Insurance Coverage
Health insurance comes in an array of options so complicated it almost seems intentional. And sometimes, the best insurance for preventive care or doctor’s office visits is terrible for emergency medicine or vice versa.
To get the most from your health insurance, ensure you understand your policy. Read the fine print to learn what your plan covers, how to access it, and what can disqualify a medical event from coverage.
Then, compare that to the likely needs of your family. Based on what you find, you might decide to change your plan by adjusting the deductible or the coverage level. Or it could be better to choose a new health plan for your family.
5. Avoid Ambulances When Possible
Ambulance rides cost hundreds of dollars, and treatment in an ambulance costs more than the same treatment in the emergency room.
Knowing where the hospitals are, which ones are best for different kinds of care, and how to get there in a hurry helps you avoid that extra cost since you can drive there yourself.
Use a map or mapping app to plan a route from your home to each hospital or urgent care clinic on your price-comparison list. It’s advisable to plot a secondary route for each in case of a blockage like traffic or construction.
If you’re using a paper map, print or write out these routes and put a copy in each car. If you’re using an app, save all the routes for future reference.
6. Organize Your Information
When you go to the ER, having the right information on hand can save you time and money. It streamlines the entry process and helps you avoid unnecessary medications or tests.
Unfortunately, it can be hard to remember medical details when you’re under a lot of stress. To make things easier, compile a list of important medical information for each family member ahead of time. Include all their health problems and medications they’re taking and update it if anything new crops up.
Keep a copy of this list in each vehicle you own along with copies of your insurance cards and insurance benefits summaries. Your insurance company must provide this summary for every plan it offers by law. Call or check the insurer’s website for a copy.
7. Ask About Costs Upfront
Unless it’s a life-or-death emergency, the best and most ethical health care providers tell you how much care costs before getting your consent for treatment. And all providers must tell you if you ask. Some emergency departments have a patient advocate who can provide this info.
Everything costs substantially more at the ER than at an urgent care facility or pharmacy. Having cost info upfront lets you make an informed decision about whether you want certain noncritical procedures, medications, or equipment.
Also, having a record of the quoted cost lets you compare it against your final bill. If the hospital charges you more than it originally said, you can use that as leverage when negotiating the bill.
In an emergency, be prepared to ask these questions or assign a family member to ask them for you:
- What’s This Treatment Going to Cost? If they say they don’t know, ask them to find out.
- Are There Cheaper Alternatives? For example, if they give you a medication, ask if you can have the generic.
- Can I Get This Equipment, Medication, or Basic Care After I Leave the ER? For example, if they want to send you home with gauze to redress a wound, you can pick it up for a few dollars at Walgreens or CVS. It could cost into the triple digits at the ER.
If you’re afraid you’ll forget to ask the questions while under stress, jot the questions down on a slip of paper. Tuck it in with your insurance card so you’ll have it when needed.
That said, there’s some care you must accept. Never pass on medically necessary treatments. Saying no to a dose of ibuprofen you can take after you leave is one thing. But the local anesthetic for your stitches is another.
8. Refuse Unnecessary Equipment
The treatment you receive at the emergency room is often just the first step in a long recovery process. Sometimes, that recovery means you need equipment at home. That can range from simple medical supplies like gauze and bandages to more specialized equipment, such as a knee or elbow brace, crutches, or a wheelchair.
Never buy that equipment at the emergency room.
In 2019, Kaiser Health News published a case study as part of its (hospital) Bill of the Month series. A soccer player with a knee injury found the hospital charged him over $800 for a knee brace that retailed for $250. And his experience is far from uncommon.
So, if you’re offered equipment like that in the ER, ask what it costs. Then check online to see what it would cost at a nearby pharmacy like Walgreens or CVS. The websites of most large drugstore chains show what’s available in stores near you.
If the ER’s markup is high, get the goods from your local drugstore instead. If you’re having trouble getting around after leaving the ER, ask a friend to help you. You’ll need to call someone for a ride home from the hospital anyway.
If the item you want isn’t available in stores, check to see how much it costs with same-day delivery. It could still be considerably cheaper than the ER’s price.
9. Don’t Accept Any Non-Vital Drugs
If you think the markup on equipment is bad, it’s even worse when it comes to prescription drugs. A 2019 PhRMA study found that the average hospital’s markup for medications was 478%. Similarly, a 2018 analysis of ER bills by Vox showed many instances of hospitals overcharging patients for meds that would cost much less at the drugstore.
If a doctor or nurse prescribes or brings you medication, ask if it’s medically necessary or if there’s a nonprescription alternative.
If the doctor says you need medication in the ER, take it. But for anything they want to send home with you, get a prescription and fill it at a third-party pharmacy for a fraction of the cost.
10. Get Everyone’s Name & Job Title
If someone you don’t recognize comes to provide you with care, ask who they are and what they’re there to do. Hospitals don’t generally try to sneak expensive procedures past you like villains in a bad TV show. But you also can’t count on them to provide only the services you absolutely need.
If somebody’s there to perform a procedure of any kind, find out what you can about it, including how much it costs. That allows you to refuse it if it’s unnecessary.
You don’t want to refuse treatment that’s important to your care and recovery. But you can use this opportunity to avoid treatments, tests, or second opinions you can either get later through your regular doctor or safely miss entirely.
11. Check Your Bill
When you receive your hospital bill, check it for errors before paying. Never skip this step. Billing errors from hospitals are so common and expensive that there are people whose whole job is to look for and fight them.
If you find an error or anything that might be an error, contact the billing office as soon as possible and let them know you plan to dispute the charges. The Fair Data Collection Practices Act says you have 30 days from the date of receiving your bill to dispute it.
Send a written notice of all the charges you believe are in error. You’ll probably go through several rounds of back-and-forth negotiations, but you’ll usually settle on a lower bill.
Ask for an Itemized Statement
It’s hard to negotiate or contest a bill when you don’t know all the details. That’s why many hospitals just send you the total or a top-level summary of what you’re paying for.
Ask for something fully itemized so you know exactly what they want you to pay for. Get a list of every pill you took, every procedure performed, every nickel spent. It’s an essential tool for checking and disputing your bill.
Once you get the bill, go over it for any obvious errors, like double billing. Then compare it to your notes about what you consented to and refused. As you go, take notes about what to report or contest.
Negotiate the Bill
There’s a very thin silver lining to bloated emergency room pricing. The fact that they pad their bills so aggressively means they have room to negotiate on the bill. You might be surprised how deeply they can discount your charges if you ask.
To negotiate your medical bill, call the hospital’s billing department. Ask to speak to somebody with the authority to negotiate a payment or payment plan.
Start by explaining your financial situation. Most hospitals have financial assistance programs for people who can’t afford to pay their bills. Some hospitals also offer uninsured discounts for patients without adequate insurance. Be prepared to provide documentation, such as a tax return, to prove you can’t afford the charges.
If your hospital doesn’t offer an uninsured discount, you’re probably paying the maximum rate for your care. Ask if you can pay the bill at the Medicare rate instead. Many hospitals bill Medicare patients at a lower rate than those with private insurance.
Another way to negotiate is to check the price against Healthcare Bluebook. This site shows the typical price for different medical procedures in your area. With a free account, you can check the prices of up to 10 medical procedures each month. If you can prove your bill was over the average, the hospital may agree to lower it.
With a combination of these strategies, patient Shannon Harness tells CNBC he managed to get an $85,000 bill for an appendectomy reduced to around $19,000 in 2020. However, it took him six months of negotiations plus a news story about his billing problems. So be prepared to spend a lot of time on the negotiating process if you’re seeking a significant discount.
Request an Audit
During an audit, the hospital’s billing department goes over your bill looking for errors. Although that might sound like asking a burglar to watch your house while you’re on vacation, it can help in two crucial ways.
First, most hospitals are honest when they catch an error. They note the problem and adjust your bill accordingly. The department responsible for auditing is more experienced at finding mistakes than you are, so they might catch things you missed.
Second, an audit takes time. The hospital doesn’t require you to pay your bill until it completes the audit. If you were caught without emergency funds sufficient to cover the bill, that can give you a few weeks or even months to find the money to pay. And it saves you the credit card or loan interest you’d pay in the meantime.
Hire an Advocate
If you don’t feel up to navigating and negotiating your own emergency room bill, you can hire an expert to help you.
There are two categories of people who make their living helping people manage medical bills. Medical billing advocates deal directly with hospitals, while claims professionals help you negotiate with your insurance company.
Wherever possible, work with an advocate who gets paid based on a percentage of the reduction in your bill instead of a flat fee. That way, they have an incentive to save you as much money as possible.
12. Pay the Total Bill in Full
If you make too much money to qualify for a reduced rate, there’s another way to have your medical bill reduced. Offer to pay the whole bill upfront in exchange for a discount.
Paying in full saves the hospital a surprising amount of money. They don’t need to send statements, make calls, or pursue nonpayers. Most hospitals are willing to lower your bill to avoid these costs.
Ask the billing department about a cash discount for payment in full. Most larger hospitals, networks, and health maintenance organizations (HMOs) have a cash discount policy in place to make it easy. According to Consumer Reports, you can usually get your bill reduced by 15% to 20% this way.
13. Ask for a Payment Plan
If you can’t negotiate the cash price down to what you have on hand, ask to set up a payment plan instead. Most hospital billing offices are willing to break up a hefty bill into a series of monthly payments that are easier to handle.
However, before agreeing to a payment plan, ask about interest and fees. Most hospitals offer no-interest plans, but some include high billing charges. Depending on the rate, it could be cheaper to pay your bill with a medical loan or medical credit card such as CareCredit.
One problem with medical expenses in the United States is that the demand for health care is inelastic. That means the price doesn’t tend to deter people from buying it as long as they have or can get the money.
That’s doubly true when it comes to emergency medicine. People use this service in life-threatening situations when price is no object. If your child has a skull fracture from a bicycle accident, you’ll agree to pay whatever it takes to make it better.
That doesn’t mean hospitals and ER staff are intentionally trying to rip you off. But it does mean you need to be vigilant about keeping costs down.
Paying attention before and during your visit and following through afterward can prevent a medical emergency from turning into a personal finance emergency too.