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Health Care Reform:

Health Insurance & Affordable Care Act

Health Insurance: 5 Tips for Emergency Room Visits

3. Know Your ER Rights

The Affordable Care Act requires insurance companies to cover care you receive in the ER if you have an emergency medical condition. You don't need to get approval ahead of time, and it doesn’t matter whether the hospital or facility is in or outside of your insurance network.

But the key words are "emergency medical condition." That means your symptoms are bad enough for you to think your health will be in danger if you don't get care right away. If you have time, try to check with your usual doctor first.

4. Could My Doctor Do This Test Later?

You may need a lot of tests while you are in the ER to figure out what’s causing your health problem. This is especially true when you have a medical emergency. But tests done in a hospital can cost a lot more than they would if done elsewhere.

If you are able, ask your ER doctor if there's any risk in putting off tests and scans until you can see your family doctor, who might decide you don't need them. If you do need them, they'll likely cost less in a doctor's office than they will at the ER.

5. Check ER Bills Carefully

You should be charged in-network rates for most of the care you get at the ER. During your stay, though, you might be treated by someone outside your network. This could be a technician or a specialist. Those providers can bill you directly for the difference between what they charge and what your health plan pays. Most plans will cover all ER fees when you're treated for a true emergency. But you may have to submit them yourself to your insurance company.

Check all your ER bills and insurance reports carefully.

WebMD Medical Reference

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