Going to the emergency department for healthcare services is expensive, and health insurance carriers are clamping down on what they will and will not reimburse. Depending on a patient’s symptoms, illness or injury, it’s the right place to go for care in many instances. But it’s still overused, and it’s costing health plan members, employers and hospitals.
BlueCross BlueShield of Georgia announced more than a year ago that it would no longer reimburse emergency room visits it deemed unnecessary. Instead, the insurance company encourages its health plan members to use telemedicine, convenience clinics or urgent care centers to receive non-emergency but urgent healthcare services.
Why exactly is emergency room healthcare so expensive?
According to data released late in 2018 by the Health Care Cost Institute (HCCI), emergency room spending per person grew 99 percent between 2009 and 2016 despite utilization remaining steady. Why?
There are many reasons for this increase, including more patients presenting at emergency rooms with high severity illness and injuries. Another reason is that according to federal law, hospitals and healthcare systems are required to provide emergency care to all patients even if they have no health insurance or ability to pay. Hospitals are left with billions of dollars of uncompensated care, and those costs are passed on to government and private health insurance companies through higher charges.
Of course, patients experiencing an emergency health condition or injury should go directly to the emergency room. But for those cases where you have time to seek lower levels of care, it would be financially prudent to do so. Let’s look at the options.
Sore throats, earaches, low-grade fevers, flu-like symptoms and mild injuries can often be addressed by your regular physician’s nurse line. Try calling the after hours care line first. As an established patient, some doctors will provide healthcare advice via phone.
If that isn’t an option, many insurance carriers now sponsor telemedicine healthcare. While patients have been slow to adopt this super accessible form of care, it’s wise to understand your benefits. Using your smartphone, tablet or computer, you can log in and virtually see a physician in minutes. They’re capable of assessing and diagnosing conditions and even prescribing medications in some cases, all for a similar fee to your office co-pay. Plus, you don’t have to leave the comfort of home.
In the event you need to be seen, seek out convenience care clinics covered by your health insurance plan. You often won’t wait long to be seen by a nurse practitioner or other licensed healthcare provider. They can diagnose conditions and prescribe medication. The fees may be slightly higher than office co-pays, but far less than a visit to urgent care or the emergency room.
While these are great options for minor illnesses and injuries, there are times when you need access to higher-level care. In these situations, urgent care centers are a great alternative to emergency rooms. Many have labs, x-ray machines and other diagnostic equipment to diagnose. The costs are going to be lower, generally less than half that of an emergency room.
When you or a loved one is ill or injured, it’s tempting to seek out the best care possible. Use sound judgment when determining if emergency care is necessary. Difficulty breathing, chest pain, open wound fractures, significant changes in mental status are just a few issues that would justify an immediate trip to the ER, but when possible, use right-level care. And as always, research your health insurance network each year so you’re aware of in-network providers at all care levels. It can save you thousands in out-of-network and unreimbursed costs.
Have additional questions about your health plan benefits? Please talk with your human resources department or your PBG representative.