Surviving the Emergency Room, Part 4: The Insurance Card and Paying for Care

monster health insurance bill

Scary medical bills

Last time, having made it to the actual exam room, or “Inner Sanctum,” you experienced first hand the excitement, fears, entertainments and humiliations the ER has to offer. Of course, all this comes at a price. In this installment we will explain the value of the insurance card, the importance of having it with you when you arrive, and what to do about the ridiculous bills you’ll get if you don’t have one.

Once you have had your Medical Screening Exam it is OK for us to ask about your insurance status. We need to do this for a number of reasons, and getting paid is only one of them. The healthcare system is complex and the type of insurance you have will determine which consultants we can call, who your attending physician will be if you get admitted to the hospital, and which hospital we can admit you to. For these reasons it’s important that you have your insurance card with you when you arrive.

If you have no card, and we have no prior information about you in our files, there could be problems. If your condition is such that you need to be hospitalized, and your regular doctor isn’t on staff at our hospital, you will be taken care of by the on-call physician. If the next day your card materializes and indicates you have an HMO that contracts with a specific medical group working at a certain hospital, a ruckus will ensue. If the HMO determines that at the time of hospitalization you were stable to be transferred to their contract facility, they will refuse to pay the on-call, non-contracted doctor and the hospital. This potentially leaves you on the hook for a very large bill.

The on-call doctor and the hospital CEO will blame the ER for the mix-up. Blaming the ER is convenient and whenever something goes wrong it’s the first thing the affected parties will do. We’re used to it, but it doesn’t mean we enjoy it. When the dust finally settles, it is likely the doctor and hospital will get paid something for their trouble, you will get transferred to the contracting hospital, and no one will try shaking you down for the balance. Nevertheless it will have been unpleasant and unnecessary, so keep your insurance card next to your medication list.

If your medical condition is such that you are deemed unstable for transfer, none of the above matters. In cases of true emergency admissions your insurance company, whichever it happens to be, will pay the bills until you are stable.

If you have no insurance you will not be denied care. We are legally and morally obligated to take care of you, and we will. If you need to be hospitalized you will be; if you need surgery you’ll get it. You will, though, be responsible for the bills, and the bills will be ridiculously high. Understand that no one expects you to pay full price. Not even close. You will be able to negotiate for the lowest amount the hospital accepts from its worst payer—usually Medicaid. You will be given a payment plan. If you are truly indigent you’ll probably be allowed to walk on the whole amount. Despite what you read in the news, none of us wants to send you to the poor house.

Next Time

Next time, privacy and the place for family and friends in the exam room.

Dr. Jim Pagano, MD, FACEP, is the chief medical officer of Precision Scribes and has over thirty years of emergency medicine experience. He’s seen everything an emergency physician can see, and more than a few things they should not.