Imagine that you went to the grocery store, did your week’s worth of grocery shopping, loaded the groceries into your car, buckled up and pulled out of the parking lot. You looked both ways before proceeding into the intersection, only to get broadsided by a driver running a red light. You called for emergency help, and the ambulance came and took you to the nearest hospital emergency room. Your medical care should be the first thing on your mind, but the expense of the situation may be what actually worries you.
According to consumer advocate and economist Ted Bauman, “I’ve always had a keen interest in protecting consumers from big business.” In today’s large hospital systems, healthcare is a big business. People don’t know how much they will be charged or what their share of the charges will be. Even with private insurance, a trip to the ER could be a financial disaster. As a finance pro, Ted Bauman offers these tips to consumers.
These tips are designed to prevent you from getting ripped off when you need to visit the hospital’s emergency room.
1. Research Emergency Rooms Now
An emergency can happen any time. Chances are that if you have an emergency, it will be at or near your home. Mr. Bauman recommends that you take some time now to research your local hospital emergency room options. Call the places and ask which ones accept your insurance. Ask what their prices are for triage, waiting, seeing a physician, X-rays, CAT scans, MRI studies and medication administration. When you need an emergency room, you will already know which one will cost you the least amount of money.
As the previous editor of Smart Money Alert, Ted Bauman has a lot of experience helping people avoid getting ripped off in countless settings, including the emergency room. Mr. Bauman recommends that you create an advance directive that stipulates which emergency room you should be taken to if the situation arises. Keep a copy of the directive in your wallet. Tell your friends and family. Keep a copy at home, too.
2. Go to an Urgent Care for Situations That Are Not Life-threatening
Ted Bauman, who is a writer and expert on asset protection, privacy, international migration issues and low-risk investment strategies, recommends that consumers visit an urgent care if the situation is not life-threatening. In most cases, an urgent care charges less than a hospital emergency room. They can treat conditions and injuries such as infected wounds, sprains and sinus infections. You might not have to wait as long at an urgent care in order to receive medical attention. If your situation is more serious, the physician at an urgent care center can refer you to the most affordable emergency room.
3. Question Unreasonable Tests and Procedures
Mr. Bauman’s international experience and education at the University of Cape Town also gave him experience in the ways that other countries handle hospital emergency room visits. His education abroad also allowed him the opportunity to meet clever people who were able to get the information that they needed in order to make informed financial decisions. In his experience, other countries do not immediately order every possible imaging study or procedure. Doctors at hospitals abroad are more likely to do a thorough physical examination and take a detailed history of your symptoms before ordering tests or imaging studies. Mr. Bauman recommends that you ask first if a test or procedure is necessary or if it is covered by your insurance. For example, a doctor might want to order an expensive MRI scan when an X-ray would be nearly as useful for diagnosing your condition.
4. Insist on In-network Providers
Just because you go to an emergency room that is in your insurance company’s network, it does not mean that every provider who takes care of you will be in your insurance network. You might not even be able to ask the providers if they are in your network. For example, you may not have any contact at all with the radiologist who sits in a room and reads your X-ray. If you are unconscious when admitted to the emergency room, you might not be aware of who is caring for you. You may not have any contact with the pathologist or laboratory technician who run your lab tests and create the report of your results.
At some emergency rooms, you may not have a choice as to which radiologist reads your X-rays or which pathologist looks at your specimens. When you sign the admission and treatment consent forms, you have the right to demand an in-network provider. You can write “in-network only” on your consent for treatment and financial responsibility forms. You can also create an advance directive with this information. It is the hospital’s responsibility to adhere to your documents for treatment.
5. Demand an Itemized Bill
In his work writing and editing at The Sovereign Investor Daily, The Bauman Letter, Plan B Club and Alpha Stock Alert, Ted Bauman explains, “I enjoy helping people avoid corporate greed.” Emergency room visits are notorious for up-charges and adding expenses that do not relate to the services you received. You have the right to demand an itemized bill. This bill should list every item that the hospital has charged your insurance company and you. It is not unheard of for the hospital to charge $60 for giving you an ibuprofen while you wait to be seen by the emergency medicine physician. They might also charge you a separate medication administration fee for handing the pill to you. Hospitals might bill you for supplies that were never used in your treatment. You can dispute any of these charges.
6. Take a Close Look at Your Explanation of Benefits
Once providers send bills to your insurance company, you will receive an explanation of benefits (EoB). Closely look at your EoB. If any of the providers were out-of-network, you can ask your insurer to negotiate directly with the provider on your behalf. Compare each bill with the EoB in order to ensure that you actually received the service. Some hospitals do balance billing or double-billing. Balance billing happens when the out-of-network provider charges more than what your insurance company says is usual and customary for the service, procedure or equipment. Double-billing refers to the use of physician extenders. You might get a bill from a doctor you never saw. It could be that a nurse supervised by the doctor saw you. Hospitals allow both the direct provider and their supervisor to send you a bill. Refer to your insurance plan to see if these practices are allowed.
Healthcare is a business in the USA. Just like you negotiate at the car dealership, you can negotiate over your emergency room bills. After verifying that the amounts you owe are correct, you may be able to negotiate the amount that you have to pay. If you can immediately pay a lump sum, the hospital may be more open to negotiation. Ted Bauman advises that negotiating with the hospital could yield a positive outcome for you, and you risk nothing by attempting it.