Since open enrollment has started for 2022, I thought I’d go back through my topics list from Chronic Disease Month [https://wp.me/p9Ay2g-hp] and start with the ones that could impact your insurance choice. I’m going to fight my urge to ramble and keep this short so you can find the information you need.
Choosing Your Emergency Room
Many people with chronic illness end up going to the Emergency Room at some point. You’ll need to know which ER to go to before you have an emergency. You’ll also need to have a way to communicate this information to others when you’re incapacitated.
Let’s start with a quiz. You have to go to the Emergency Room. Your driver – whether it’s someone you know or an ambulance driver – will need you to tell them which one to go to. Each ER is affiliated with an excellent hospital, so you’ll get good care either way.
Which of these options do you choose?
- The nearest one – it’s only 2 miles away, and you can get there in about 5 minutes. It’s affiliated with an out-of-network hospital.
- The next closest one – it’s 10 miles away, and you’ll get there in about 20 minutes if there are no accidents on the highway. It’s affiliated with a hospital in your network.
- Why does it matter? Insurance covers Emergency Room services regardless of whether the ER is in or out of network.
The answer seems so simple – go to the nearest one. The right answer is to go to the ER affiliated with the hospital in your network. And while insurance does cover emergency costs the same way for hospitals in or out of network, going to the wrong ER could be a costly mistake.
If you’re hospitalized…you need to be hospitalized at the hospital in your network. You will have a much larger bill if your hospital is not in your network.
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- Hospitals expect you to foot the bill for a much larger percent of costs for out of network hospitals. For example, my insurance covers basic in-network hospitalization with a small copay for the first 5 days, then no copay after that. My out-of-network costs are 50%. In the US, an overnight hospital stay is $11,000 in most places. Your out-of-pocket costs are much smaller at an in-network hospital.
- You don’t get just a big bill from the hospital. You’ll get separate bills from every doctor who saw you while you were there. Odds are that if the hospital is not in your network, those doctor’s won’t be either. You’ll need to pay the higher copay for each out-of-network doctor.
- Your copay for tests will be much higher at the out-of-network hospital. My insurance charges a 50% copay for testing done outside of the network.
- Maximum out-of-pocket expenses are treated differently. On my policy, my annual maximum for in-network costs is around $7,000. The annual maximum for combined in and out-of-network costs is over $11,000. None of the out-of-network hospitalization costs would count toward that lower number. If you’ve met your out-of-pocket expenses during a year, you’ll generally pay $0 for the rest of the year. You’ll pay more to reach the out-of-pocket minimum for the year.
- Know how your insurance covers ER costs during the current year. Insurers used to charge a set dollar amount for the ER copay, but that may not be the case anymore. I have relatives who paid a $650 copay in 2020. They kept the same policy, but their insurer is now charging a percentage copay in 2021 instead of a set fee. Now ER visits can lead to a higher copay, and you have no idea how much it will be until you get the bill.
- Hospitals handle financial assistance in different ways and may cover a different percentage of the cost. When I was hospitalized, the hospital’s financial assistance program responded quickly and covered all of our bills. My son’s policy is with a different provider, so he went to a different network hospital. It took us more than 6 months to get a decision from that hospital. His assistance request was rejected, and he had to pay our entire bill. We submitted the same information to each hospital, but they came up with far different assistance programs. Do not expect financial assistance programs will help you. If you still have out of pocket expenses after applying for financial assistance, you can contact the business office and arrange a payment plan that spread out the costs for you,
Summary
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- Know which Emergency Room you need to use before an emergency arises to minimize potential medical bills.
- Communicate with your driver so that they’ll know which ER to go to. Know the name and basic directions to the right ER. If you’re incapacitated, make sure your ER choice is clearly documented. If you have a smartphone, use it.
- Prevent admission to an out-of-network hospital by going to an in-network ER. Your wallet will thank you for it.
- Review your policy each year to find out coverage changes that could increase your out-of-pocket responsibilities. Compare your coverage to other available plans so you can evaluate whether keeping your current policy and accepting those changes is the right decision for you.
- Request financial assistance but understand that your request could only cover part of your costs or be completely rejected.
Click on the link to find out more about medical costs: Debt.org
Medical bills are related for an estimated 60-65% of bankruptcies. Do what you can now to avoid becoming part of that statistic later.
