Worried about going to the emergency room without insurance? Lack of insurance shouldn’t stop you from going to the emergency room if you have a true medical emergency.
Can you go to the hospital or emergency room without insurance? The answer is yes. However, while you must be treated regardless of insurance coverage, financial status, citizenship, or otherwise – the cost for your care when going to the ER without insurance can add up extremely quickly if you’re not careful.
Even if you’re in a position to be concerned about emergency room costs (and if you’re having a heart attack or other major medical emergency its highly likely you won’t be), it’s still extraordinarily difficult to do so. The doctors and nurses who treat you are focused on the best quality treatment and have little knowledge of what a test or procedure might cost (since this is an entirely different department).
ER costs are rising rapidly (one study found that they increased by 176% over the last decade) and this is unlikely to get better.
We’ll dive into why emergency room costs are increasing and then discuss what you might be able to do about it.
Increasing Costs of Emergency Room Visits: What to Know
Every emergency visit is assessed on a scale of 1-5, supposedly corresponding to the severity of the ER visit. One being the least severe (e.g. an insect bite) and 5 the most severe (e.g. severe burns, chest pains, etc). If you really want to dig into this, the American College of Emergency Physicians has some great guidelines on how these are coded.
As one would expect, the more severe an emergency room visit, the more the hospital can bill for the charge. While certain criteria need to be met to code at a given severity level, this criteria is loose enough that it can be easy to game the system – and it looks like that’s what’s currently being done. According to a Healthcare Cost Institute Report while only 17% of hospital visits were coded as level 5 in 2008, that number ballooned to over 27% by 2017.
Charges for other emergency room services are then adjusted based on the severity level. This is how you get the $200 ibuprofen and $100 band-aids stories that are all over the news.
On top of that, hospitals are increasingly marking up their costs across the board. A Johns Hopkins University study found that some hospitals are marking up their prices by over 1,000 percent (And our internal studies found the average hospital markup is over 4x their costs). Of course insurance companies don’t pay these rates (they negotiate their own rates behind closed doors and fight every effort to release those rates.) Only the patients going to the emergency room without insurance are forced to pay these exorbitant amounts.
Finally, in general, emergency room services are not shoppable. That is, it’s extremely difficult for the consumer to shop around for the best emergency room rate. This is due in large part because when having a medical emergency, one doesn’t have time to call the 6 nearest hospital and find which one has the best rate for a level 5 visit. Hospitals take advantage of this lack of shoppability to jack up emergency room visit prices even further.
So in sum, we have an increase in code severity to charge higher rates, massive overcharging on hospital rates in general, and a lack of shoppability that threatens to make ER overcharging even worse than general hospital overcharging.
What You Can Do About Going to the Emergency Room Without Insurance
If you have a medical emergency – you should go to the ER regardless of whether or not you have insurance. However, if you do end up with a huge medical bill, there are a few things you can do about it.
The first is to apply for hospital financial aid. Luckily, EZ-File by Resolve automates the process of applying for hospital financial assistance for you.
You can also call your local hospital and ask them to send you an application. Additionally, you can look into Medicaid, Chip, and other government programs. Section 3 of our Guide to Negotiating Your Medical Bills has some great links to finding financial aid.
Second, call up the hospital and ask for a rate reduction after you’ve gone to the ER without insurance, in exchange for paying upfront. Hospitals recognize that many uninsured do not pay their hospital bills and would rather collect something over nothing. Section 2 of our Guide to Negotiating Your Medical Bills above dives more in-depth on how to negotiate with a hospital or other medical provider. You can also read our quick 5 steps to negotiating your medical bills to learn more.
If you need help negotiating – Resolve Medical Bills can help. We run an analysis of your bills to determine hospital costs, medicare pricing, and insurance reimbursement rates and then identify a fair rate for services provided. Our expert negotiators will then get to work securing that rate from the hospital. Contact Us via filling out a form, calling directly, or setting up a free consultation.
Braden founded Resolve after experiencing first hand how unfair the system is for patients. Prior to Resolve, he built and ran Operations for a renewable energy company and then built and ran Product, Growth, and Operations for a VC-funded edtech company. He received his MBA from Dartmouth’s Tuck School of Business and BA in Philosophy from the College of William and Mary. When not trying to lower healthcare costs he can be found outdoors mountain biking, skiing, or hiking with his dog.