When you or a loved one, especially a child, is not feeling well it is very difficult to know if the ER is the appropriate place to go for help. Before the situation takes place it is a good idea to read your insurance policy or call your insurance broker. It is also wise to have the name and phone number of the nearest emergency room that is in your insurance network handy before you need it.
An individual family plan, even a high deductible health plan, all cover emergency room services but there are some details to that coverage you need to know. Some plans have what is called a facility fee. If you go to the ER and you are not admitted to the hospital you have to pay a fee even if you have met your deductible. If you do have one of the high deductible health plans this is how it works…. The deductible is $10,000.00 and your ER bill is $5,000.00 you will be paying the entire bill.
A lot of carriers offer an accident rider. An accident rider is a good idea if you have young children or a family that plays a lot of sports or if you are simply accident prone! An accident rider is first dollar coverage. It will pay the amount of money you picked when you purchased your individual family plan and the deductible does not apply. An accident rider of $1000.00 will not significantly increase your health insurance premiums, but can save you loads of money.
Individual family plans, with most carriers, will also let you go to an urgent care center for the same copayment that you would pay to see a doctor. At these centers, you can usually get things like X-rays, stitches and care for minor injuries that aren’t life threatening yet require immediate medical attention.
Most senior health plans like Medicare allow you to go to the ER with either a small copayment or no copayment at all. It is recommended to visit the hospital emergency room for a variety of serious problems, such as severe bleeding, head trauma, seizures, meningitis, breathing difficulties, dehydration and serious bacterial infections.