Michael E. Makover, MD FACP, Chief Medical Officer JIBEI
Misunderstanding how your health plan covers the use of the Emergency Room might cost you thousands of dollars. Learn how your Plan works and how you can give yourself the best chance for using the ER most effectively.
ERs are very expensive
Emergency rooms are one of the most expensive services in healthcare. A simple cold seen in a doctor’s office may cost perhaps $100 or less. That same care in the emergency room could cost over $1,500, sometimes way over that.
When you need them, ER’s can be lifesaving. However, too often today they are used as if they were primary care doctors’ offices.
How your benefit plan works
Your benefit plan covers ER visits that are for “Sudden and serious diagnoses”. That means something:
How can you be sure? You are not expected to be a medical expert. Thus if you go to the ER fearing a serious illness that suddenly came on, most likely that will not be questioned. However, if you had those symptoms for many days, or could have gone to your doctor or an urgent care office first during the day, or could have waited for the next opening at the doctor’s office, then it might not be covered.
If your visit does not meet the standard, then you will have to pay the ER yourself, very often more than $1,000.
If you can, call MagnaCare beforehand (877-624-6210). They can give you some idea of if it will be covered, though that is not binding since they have limited information by which to judge. You will still need to think carefully about whether to go or to wait. If not beforehand, try to call from the ER or within 24 hours afterwards.
Never delay going to the ER when it is a true emergency! Much worse than going to the ER when it is not necessary would be not going when you really do need emergency care.
Thus the difficult choice – to ER or not to ER?
Here are some things you can do if it is not an obvious immediate need for emergency care:
Your health plan understands that these choices can be difficult sometimes and it gives members as much leeway as possible. However, remember also that the decisions are made simply on the basis of how to use your dollars to give the most benefit to the most people.