When you or a loved one is very sick, in a lot of pain, or otherwise in need of immediate medical care, your first impulse is most likely to visit an emergency room (ER).
In this article, I’ll explain when to visit the emergency room, what the average cost of an emergency room visit is in each state, and what factors influence the prices of an ER visit.
Then, I’ll suggest alternatives to an emergency room visit for your urgent healthcare needs.
Finally, I’ll tell you how to determine if your bill is correct and what you can do to make the cost of an emergency room visit less overwhelming.
When to Visit the ER
The top reason for visits to the ER in 2018 was injury and poisoning, which resulted in 10 million hospital admissions out of 20 million visits.
Abdominal pain, acute upper respiratory infection, and chest pain were the next highest in the frequency of visits to the ER.
While chest pains could possibly be considered an emergency, the other symptoms would most likely be treatable at an urgent care center or by a primary care physician (PCP).
If your ailment is life-threatening or causing extreme pain, it warrants a visit to the emergency room.
If you have a sprained ankle but can still walk on it with some support, urgent care is likely your best choice in terms of time and cost.
Understanding the difference between significant discomfort and severe injury will make deciding where to go for help easier.
The Cost of an ER Visit
The average cost for different kinds of illnesses treated at an ER varies depending on what’s involved in the management of the condition and whether any tests are needed.
Average Cost for ER Visits
In 2019, the average cost for an ER visit by an insured patient was $1,082.
Those who were uninsured spent an average of $1,220.
Average costs can vary by state and illness but range from $623-$3,087.
Why an ER visit is so expensive
Emergency rooms are very expensive operations to manage for a few reasons.
For an emergency room to be ready to treat patients with acute medical problems, they need to have a lot of high-cost equipment, which requires frequent maintenance to ensure operability, medical supplies, medications, and items such as gowns, bedding, beds, and monitors.
Secondly, since emergency rooms run on a 24-hour schedule, a lot of personnel is needed to keep them optimally staffed.
That staff includes everyone from maintenance people to trauma surgeons.
These costs all get passed on to the insurance companies and the patients who visit the emergency room.
How costs are determined
In addition to direct care costs, when you register as a patient at an emergency room, you’re also charged a facility or triage-fee.
Beyond that, costs are determined by the hospital, which can vary widely from location to location.
Some of the cost factors include:
- Supplies used
- Medications given
- Number of attending doctors, nurses, and ancillary staff
- Tests required
- Equipment used
Check with your insurance to see if you have emergency room coverage.
Even if you have this coverage, you may still have a costly bill, which can depend on whether you are being seen in an in-network facility, and how your insurance plan is structured.
This situation arises partly because of balance billing.
Insurance companies negotiate rates with hospitals like they do with all doctors.
As a result, your insurance may not have a good rate with a hospital you visit, which could impact your bill.
You will also need to meet your deductible before your insurance covers your visit, so if you have a $2,500 deductible, you’ll have to pay that before the rest of your emergency room bill is covered.
Alternatives to the ER
The ER is not your only option when it comes to medical care. Consider these alternatives (unless you are facing a medical emergency in which you should call 911):
Primary care provider
Your PCP is the best person to see for all your non-life-threatening health concerns.
Some PCPs may have busy schedules that will require you to wait a few days before seeing them for acute care, but most will be able to either prescribe medication or send you to local urgent care for immediate help.
In addition, some PCPs have a physician assistant (PA) or nurse practitioner (NP) that you can see right away.
Many also have after hours phone advice lines that are covered by ancillary providers or the provider themselves, to help you decide what care you need.
Scheduling regular, annual check-ups with your PCP will help you maintain your overall health.
Your PCP can provide care or help you find the proper care for any of your health concerns.
Urgent care can be a good option for uncomfortable ailments that aren’t life-threatening.
If you live in or near a suburban or urban area, you should be able to find an urgent care facility that’s open after hours and on the weekend.
These are some medical issues that can probably be taken care of at an urgent care facility and will help you avoid the expense of visiting an ER:
- Bladder infection
- Body aches
- Ear infection
- Excessive vomiting or diarrhea
- Minor burns
- Severe sore throat
Telemedicine continues to increase in availability and ease of use.
It’s an excellent way to see a doctor for less serious problems, including acne, birth control, urinary tract infections in younger people (seniors should be seen in person by a doctor for these), and other minor issues.
Also, the cost of telemedicine can be far less than urgent care or a PCP visit.
If you don’t have insurance, are concerned about the cost of meeting your deductible, or have high co-pays, a free clinic may be an option that works for you and your family.
You can find a free clinic in your community by contacting the National Association of Free and Charitable Clinics.
Disputing a Surprise Medical Bill
If you are faced my a surprise medical bill, there are ways you can dispute it.
Identify the codes
As mentioned earlier, a significant factor in the cost of an ER visit is the level of care required. So when you get your bill, check to see how your visit was coded.
This will indicate the complexity of decision-making that was required in your care. .
The codes for ER visits are below:
- 99281–Straightforward (level one)
- 99282–Low (level two)
- 99283–Moderate (level three)
- 99284–Moderate to high (level four)
- 99285–High (level five)
Know your rights
The No Surprises Act of 2022 protects insured people from receiving surprise medical bills when they receive most emergency services.
In addition, the No Surprises Act ensures a dispute resolution process for those questioning their bill, whether they are insured or not.
If you believe that your medical bill is more than you should be paying, there are several things that you may be able to do in order to help lower this cost.
You can negotiate with your insurance company if it is an out-of-network provider, ask the hospital for an adjustment of your bill based on your age or your income, or ask for a discount by paying the entire bill at once.
Keep trying, and ask for management if you don’t get the response you want from customer service at either the insurance company or the hospital.
It never hurts to ask.
Many hospitals can also work out payment plans if the bill in entirety is too high to pay all at once.
Some hospitals also have financial aid programs to help with bills if you qualify according to their inclusion criteria, which will usually require a closer look at your finances.
How K Health Can Help
Did you know you can get affordable primary care with the K Health app for non-life-threatening situations?
Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a provider in minutes. K Health’s AI-powered app is based on 20 years of clinical data.
Frequently Asked Questions
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
Costs of Emergency Department Visits in the United States, 2017. (2020)
18 Million Avoidable Hospital Emergency Department Visits Add $32 Billion in Costs to the Health Care System Each Year. (n.d.)
Emergency Department Visit Rates by Selected Characteristics: United States, 2018. (2021)