If you go to an emergency room, you’ll be seen even if you don’t have insurance. But depending on your situation, it may not be the right place to start when you need care.
A good rule of thumb is to only visit an emergency room if your situation is life-threatening. If your medical issue isn’t life-threatening, a clinic or urgent care visit should cover what you need, plus it’ll likely cost a lot less and be more convenient.
Here, we’ll go over the average cost of a visit to the emergency room, why that visit can vary so much and why it may be higher than expected. We’ll also go over how to assess your symptoms so you don’t pay for care you don’t need and don’t strain emergency room resources that could help others with more serious situations.
What is the average emergency room cost without insurance?
If you’ve ever received care from an emergency room, you probably felt sticker shock when you opened the bill, because the average cost of a single emergency room visit in the U.S. is $1,500 to $3,000.
With insurance, this cost is typically less, but you’ll still likely owe a significant amount. And without insurance, you’re on the hook for the whole bill. So why do emergency care costs vary so much, and what are you paying for?
Why ER and other care costs vary so much
Emergency rooms need to be prepared at a moment’s notice for any and every type of situation and are staffed 24 hours a day, seven days a week. Because of this, they’re very expensive to run, and they’re the most expensive place to receive care. Besides staffing and equipment, factors that can influence your final cost for a care visit include:
- Where you live – If you live in or near a big city, it’s likely you’re near several emergency departments as well as clinic and urgent care options. So, you don’t have to go to the ER for a minor issue. If you’re in a rural area, though, your only option may be an emergency room, even if your issue isn’t severe, and your cost may be higher.
- The severity of your injury – ERs operate on a triage basis, meaning they prioritize patients based on the severity of their illness or injury. If you’re there for a minor issue, you’ll likely wait a long time and you’ll end up paying more than if you went to an urgent care or clinic.
- Services administered while you’re there – At the ER, you may get tests and services you didn’t expect to need. For example, if you visit the ER for chest pain, the ER doctor will likely order tests to rule out a variety of potential causes, even if it turns out to be caused by something less severe like acid reflux. And your bill can increase quickly.
How the Emergency Severity Index factors into your bill
The costs you see on your ER bill aren’t directly determined by the ER triage system. Instead, they are largely determined by how staff assess your level of medical need using the Emergency Severity Index (ESI).
The ESI has five levels:
- Level 1 – This is the most urgent. Level 1 patients are seen immediately, and typically, a lot of resources are needed for care, so it’s usually the most expensive type of ER visit.
- Level 2 – This level likely requires a lot of resources, and patients are seen quickly, because their situation could become severe at any moment.
- Level 3 – While patients at this level are still treated as though the situation could become severe if they’re not treated, they usually don’t require as many resources, and there isn’t as much urgency to be seen.
- Level 4 – Patients assessed at this level typically don’t have symptoms that are life-threatening or severe. They can wait longer to be seen and don’t need many resources for treatment.
- Level 5 – Level 5 patients’ symptoms aren’t considered life-threatening in any way, and they can wait to receive treatment. Level 5 is the lowest level of cost.
Typical charges you might see on your ER bill
ER charges vary, and there are typically multiple charges that may result in more than one bill, depending on your coverage. Some common charges you might see on your bill(s) include:
- Facility fees to pay for nursing staff, equipment, facility maintenance and anything else it takes to always keep the ER fully functional and operational
- Professional fees to cover services provided by doctors, nurse practitioners and other medical providers who treat and care for you
- Medications, equipment or supplies used
- Charges for lab tests or X-rays
- Ambulance services, if applicable
How health insurance helps cover emergency room costs
Insurance will have a major impact on what you’ll pay for your ER visit.
If you have health insurance, your emergency care should be covered, no matter where you are, at your plan’s in-network levels (although there are exceptions). The Affordable Care Act requires that in true emergency situations, health insurers in the marketplace and private insurers must cover emergency room services whether in or out of network.
Your plan will cover a portion of your costs; you will be responsible for any out-of-pocket costs like your yearly deductible, copay or coinsurance. How much is covered will depend on your health plan.
If you don’t have insurance, you’ll be responsible for the whole bill yourself. That sounds scary, but there is protection in place. The No Surprises Act helps protect patients against surprise ER bills by limiting what you must pay out of pocket.
There may be help available after you receive your bill, too. Non-profit hospitals are required to provide financial assistance, and many for-profit hospitals voluntarily provide it as well. Some states, like Minnesota, are even taking things further by requiring that hospital billing departments screen accounts to see if financial assistance is available before sending overdue bills to collections, which can save your credit in the long run.
When it comes down to it, the best way to protect yourself against catastrophic costs is to have health insurance. Even if you don’t expect to use it, you never know if you’re going to get into an accident or get injured and need emergency care. Health insurance is there to protect you from paying more than you need to.
Don’t forget follow-up care after the ER
Your emergency room visit may be one and done with no follow up needed. But depending on the services you received, the providers that see you may recommend follow-up care. This can include procedures, surgeries and physical therapy after an injury.
It’s important to check, however, that the recommended follow-ups are in network and covered by your plan. Because while your emergency services are covered whether you’re in network or not, any follow-up care should occur in network, so you’re not faced with unexpected bills.
If you need to schedule follow-up care after an emergency, check online or contact Member Services to see if the clinic or doctor you’ve been referred to is part of your network before you go. If it’s not, Member Services can help you find a different location. You can also speak to your doctor about a referral to a clinic that’s in your plan’s network.
Help reduce ER costs by avoiding non-emergency visits
Knowing what level of care you need and when you need it can be tough. A good approach is, if your health situation is severe and may result in permanent damage, disability or death – like significant bleeding, neurological changes or severe injury – the emergency room is the right place for you, even if it will cost more. If you have a milder illness or injury, like a wrist sprain or the flu, urgent care, a telehealth visit or an appointment at your clinic should be all you need to get back on the mend with a lower bill to boot.
