When you or a loved one has to be rushed to the emergency room, the last thing that should be on your mind is whether or not you will be able to pay the bills from the ER visit. However, that concern is a reality for many in the U.S. Don’t ignore this issue – you never know when you or a loved one will end up in the ER, and emergency room costs for the uninsured can be alarmingly high.
How do “markups” lead to high emergency room costs for the uninsured?
Markups are excess charges billed to uninsured and out-of-network patients. An analysis of billing records from 12,000+ ER doctors and 57,000+ internal medicine doctors found that emergency departments charges between 1.0 and 12.6 times what Medicare pays for the services.
On average, doctors and hospitals charge adult patients 340% more than what Medicare pays for these same exact services. These excess charges, or “markups,” are greater for emergency medicine doctors when compared to internal medicine doctors, who still charge excessively, but to a much lesser degree.
What does this markup look like?
An article on the analysis of markups of ER bills gives the following example:
“For a physician interpretation of an electrocardiogram, the median Medicare allowable rate is $16, but different emergency departments charged anywhere from $18 to $317, with a median charge of $95 (or a markup ratio of 6.0). General internal medicine doctors in hospitals charged an average of $62 for the same service.”
Where is this happening?
The study found that markups are occurring in all 50 states. However, ERs that charged patients the highest markups were more likely to be in for-profit hospitals, in the Southeast and Midwest, serving higher populations of uninsured, African-American and Hispanic patients.
What does that mean for patients?
Patients who don’t have insurance, and insured patients treated in out-of-network ERs, generally receive enormous bills. These ER bills are often so large they are impossible for patients to pay.
As explained above, these bill are often substantially higher than what Medicare and insurers pay for the same exact service. Simply put, when you pay for ER services out of your own pocket, you pay much more money than an insurer pays for the same exact services. Medicare and insurers have negotiated lower fees for their members, and those paying out of pocket are paying full price. It’s maddening, right?
Are you uninsured?
If you are uninsured, enrolling in an insurance plan should cover most of an ER bill, assuming you use an ER covered in your policy. Of course, when you have a medical emergency, you won’t be able to sign up in time, so the time to enroll is now.
Don’t think you’ll need insurance? Maybe you won’t. But you’ll be very happy you have insurance if/when you need it. If you need insurance and don’t have it, you may end up emotionally and financially devastated. Medical bills are a major reason Americans file for personal bankruptcy.
If you are uninsured and need immediate medical attention for a non-life threatening condition, a retail clinic might be best. Retail clinics and urgent care centers can treat conditions including broken bones, cuts, ear infection, etc, often at lower costs. For more information, read Do You Need an ER, Urgent Care or Retail Clinic?
Beware of out-of-network visits.
If the patient’s condition allows, try to use an ER covered by your insurance policy. Spend some time now – look at your policy and make a list of hospital ERs covered in your geographical area. Post the list somewhere you can easily find it, like your kitchen bulletin board, and/or type it into your smartphone. Memorize a few hospital names so you’ll know where to go in an emergency – you likely won’t have time to research. If you are traveling out-of-state, review your plan’s coverage to learn about coverage in other locations. The good news is that many policies cover ER trips when you are out-of-state.
Is the government going to intervene?
This is a problem that is not going to go away on its own. Patients do not have the power to protect themselves from these marked up bills. The good news is that state governments are starting to create laws to protect patients. New York requires bill transparency, so patients can understand costs before treatment. Maryland has a plan where prices are set at the same rate for all hospitals. Currently, at least 7 states have passed legislation to protect uninsured patients from paying what is called “chargemaster” prices, which is a list of billable services each hospital creates with highly inflated charges which are used primarily to bill those who are uninsured, out-of-network, or otherwise self-pay.
For more information…
Read these blog posts to learn more about money related matters:
- Can You Comparison Shop for Healthcare Prices? Yes, and You Should!
- The Impact of the High Cost of Healthcare
- How to Shop Around for Healthcare Pricing.
- Reduce Your Healthcare Expenses.
- Tips for Handling Medical Bills.
- How to Save Money on Prescription Medications.