Cost Vs. Care: The Price Impact on Emergency Care

Cost Vs. Care: The Price Impact on Emergency Care

Imagine you are sitting in a cold, sterile emergency department waiting room. You’ve just followed the ambulance carrying your loved one to the nearest hospital. Your hands shake as they clutch the free cup of stale coffee the nurse handed you as she kindly told you to “wait while we get him settled”. Now imagine instead of thinking about what is happening to your loved one, you’re worrying about how much this is all going to cost.

This is a harsh reality for many Americans today, even those with medical insurance. Insurance companies estimate an approximate cost of $800 for a simple emergency room encounter, not including a full range of medications, blood work, CT scans and doctor’s fees. Wait, doctor’s fees? Isn’t that included in the bill? No. Not necessarily.

Frequently emergency physicians are part of an independent group working out of the hospital, therefore their services are billed separately from the hospital’s. While the hospital you attend may be “in network” with your insurance, the physician group taking care of you may not. There is a law in place that states you cannot be billed more for attending an emergency room out of network (let’s face it, emergencies happen anywhere), however the physician group can bill you for whatever your insurance does not pay. This practice is called balance billing and can lead to substantial, intimidating medical bills for patients.

Impossible Decisions

All too often in emergency rooms across the nation, patients and families are weighing their options: get a full range of tests and specialized care or avoid a potentially hefty bill. Emergency departments are a highly efficient, and convenient, way to run a gamut of tests and the opportunity to consult with specialists all in one visit. Every emergency room visit guarantees you will be evaluated by a nurse and a physician, and perhaps a physician assistant or nurse practitioner as well. You can expect to see a radiology technician for x-rays and CT scans. You might see a phlebotomist to have your blood drawn. A pharmacist will handle your medications ordered. Ancillary staff like registration teams and housekeepers will handle other vital operations of the department. However, this comes at a price, a price many Americans cannot afford. The concern for cost is so prevalent that hospitals and emergency rooms employ financial counselors to help patients navigate the scary and confusing process of billing. Financial aid applications are routinely handed out. According to Centers for Medicare and Medicaid Services (CMS), approximately half of ER visits still go uncompensated.

Still, unfortunately, per the Kaiser Family Foundation, approximately 28.5 million nonelderly Americans remain uninsured. Because of this startling statistic, emergency rooms become both primary care physicians and specialists. A significant reason so many Americans remain uninsured is related to the exorbitant cost of the insurance itself. Even if one can afford the insurance, they are still responsible for high co-pays and even higher deductibles. Due to ever increasing copays and deductibles for those with insurance, outpatient testing and specialist visits often get delayed or even ignored. More and more emergency rooms are seeing patients with chronic conditions who present with worsening symptoms and complications from lack of outpatient care. This isn’t because they have inadequate doctors, it is because the necessary care they need is unaffordable.

Urgent Care vs. Emergency Rooms

Urgent care centers are becoming more popular because of their convenience and lower costs than emergency rooms. Most urgent cares accept a vast majority of insurances, and typically carry significantly lower co-pays than emergency rooms. Nevertheless, urgent care facilities have their limits. Urgent cares cannot draw blood work or run complex testing like CT scans. Patients are often uneducated on the major differences between emergency rooms and urgent cares, but cost is their main concern. Which is cheaper? Will I wait longer? Do I need the emergency room? And the never-ending question: how much is this going to cost?

What About the Ambulance?

Not all emergencies can wait for a drive to the hospital. Ambulances provide life-saving medical care en route to hospitals and can help get patients to the best hospital for their condition. This service, although invaluable, has a hefty price tag. Sources estimate a range anywhere from $300 to $2000 for an ambulance ride. For Medicare beneficiaries, the coverage for ambulance services can be denied if the condition is not life threatening enough for other forms of transportation. In critical moments, families are faced with: do we have time to drive ourselves? Can my loved one wait? Should we call the ambulance?

Why We Do It

Emergency rooms are blind to skin color, nationality, income, or citizenship status. They exist to save lives, to fix your broken bones, to provide life-saving antibiotics, and to resuscitate. It doesn’t matter whether you are unemployed or work three jobs, whether you live in a mansion or on the street, the emergency room will take care of you.

It is incredibly humbling to be a part of such an organization, to heal those who you know can never repay you, to care for some who may not have had a kind touch, warm meal, or soft blanket in years. There is something to be said for emergency rooms, and while it is mandated by law that emergency rooms cannot turn people away, they are filled with doctors and nurses who would choose to take care of you anyway.

-Jessica Dzubak, RN
Originally published on LinkedIn

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