Health Insurance: 5 Tips for Emergency Room Visits

Medically Reviewed by Amita Shroff, MD on July 08, 2020

If you're at the emergency room (ER), you are probably there because you're dealing with a serious medical problem.

While you are there, you will have to answer questions about your medical history and your health insurance. You might have to make important decisions about tests and procedures, too. Being prepared may help you avoid huge medical bills.

Here are five tips to get better and more affordable care during a medical emergency.

1. Don't Assume the ER Is the Right Place for You

You might avoid a long wait and save a lot of money by going to an urgent care center instead of the ER. These centers can handle many illnesses and injuries that used to be treated only at an ER, such as:

  • Burns
  • Broken bones
  • Cuts that require stitches

Save the ER for life-threatening conditions like seizures, serious head injuries, and severe pain, such as pain that could point to a heart attack or stroke.

A few tips:  Many urgent care centers take insurance coverage. Ask if your plan is accepted. If you are taking your child to an ER or urgent care clinic, try to use a pediatric center or one where there are pediatricians on staff.

2. Be Ready to Answer Questions About Your Health

Whether at an urgent care center or the ER, the doctor treating you will need good information to give you the best care. If possible, be ready to provide your medical history when you arrive at the ER, including:

  • A list of all medications or antibiotics or supplements you're taking, have been recently prescribed, or recently completed
  • Any allergies you have, especially to medications
  • A list of previous stays at the hospital and diagnoses you have received
  • Information on any past surgeries
  • A list of past or chronic illnesses
  • Health problems that run in your family
  • Vaccines you've received
  • Any specialists (including their names) you may be seeing

It's a good idea to store all this information on your cell phone using a medical records app. Or if you prefer, write down your medical information and keep it in a place where you can grab it quickly. That way, you won't have to try to remember all of it when you're sick or hurt.

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 primary care doctor, who might decide you don't need them. If you do need the tests but it's not an emergency, 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 the ER doctor, 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.

Show Sources


Nationwide Children's Hospital: "ED vs. Urgent Care."

Palo Alto Medical Foundation: “When Should Urgent Care Services Be Used?”

Nemours Foundation: "Going to the Emergency Room."

Families USA: "The Patients' Bill of Rights."

Academic Emergency Medicine: "Rising Annual Costs of Dizziness Presentations to U.S. Emergency Departments."

FAIR Health: "Out-of-Network Docs at In-Network Hospitals."

© 2020 WebMD, LLC. All rights reserved. View privacy policy and trust info