How Caregivers Can Negotiate an Emergency Room Bill

From insurance coverage to medical bills, this article covers everything you need to know to navigate the tricky world of emergency room visits.
Published on
March 17, 2023
Written by
Katie Wilkinson
Katie Wilkinson
Reviewed by
Presented by Givers
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An emergency room bill can cost thousands of dollars. Caregivers not only have to worry about their health but that of their loved ones. If you or a loved one visited the emergency room, you know that the cost of healthcare in the United States can be astronomical. While insurance may cover some costs, you may still be left with ridiculous out-of-pocket costs. Fortunately, paying your medical bill and saving thousands of dollars is possible. Learn the importance of negotiating an emergency room bill, provide tips for negotiating, and offer guidance on what to do if you can't afford your bill.

How much does an ER visit cost on average?

The cost of an average emergency room visit in the United States can vary greatly depending on several factors, such as the severity of the medical condition, the location of the hospital, and whether the patient has insurance. Without insurance, the cost can range from $150 to $3,000 or more, depending on the services rendered. With insurance, the out-of-pocket costs for an ER visit can vary from $50 to $500 or more, depending on the type of insurance plan and deductible. However, it's important to note that insurance coverage can significantly reduce the overall cost of an emergency room visit for patients in the United States.

Negotiating an emergency room bill

Negotiating an emergency room bill helps you avoid financial hardship and debt. Emergency room visits are often unexpected, and the cost can escalate. Ensure that you only pay for the services you receive. 

Tips for negotiating an emergency room bill

When contacting the hospital or billing department, be prepared to explain your financial situation and any insurance coverage you have. Explain you cannot pay your medical bill. Request an itemized bill to review charges in detail, and don't be afraid to ask for a discount or charge reduction. Sometimes, you might need to contact a patient advocate to help you and your loved one negotiate the bill. Don't be afraid to reach out for help and assistance. 

Negotiating an emergency room bill with insurance company

Yes, you can negotiate your emergency room bill with your insurance company. But how? Contact your insurance company and explain your financial situation and why you are disputing the charges. Provide documentation supporting your case and follow up to ensure a timely review of your appeal. Be honest about your financial situation. 

The truth? The hospital does not want to move your bills to a creditor. As long as you are honest about paying back your bills within your financial limitations, they will work with you. So what are the five steps you need to take to negotiate your emergency room bill

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Strategies for negotiating an emergency room bill

1. Gather information and documentation

Before you start negotiating, gather all the information and documentation you need. This includes all bills and invoices, medical records, and insurance policies. Organize any communication between you, the hospital, and the billing department. The more organized, the better. What you may need: 

  • All bills and invoices related to the emergency room visit
  • Medical records and itemized bills to ensure the accuracy of charges
  • Insurance policy to understand coverage details
  • Explanation of Benefits (EOB) from your insurance company
  • Any correspondence with the hospital or billing department
  • budget that outlines your financial situation and ability to pay the bill
  • Notes on any phone calls or conversations with the hospital or billing department, including the name of the representative you spoke with and the date and time of the conversation

If you are gathering this information for a loved one, you may need to contact their insurance company, medical professionals, or attorney to gather the correct information. During a medical emergency, collecting all the documentation will not be a priority on your mind. But be sure to save everything. Having a designated folder for all these papers will help keep documents organized. 

2. Contact the hospital or billing department

Review your medical records and note any discrepancies between charges and your treatment. Double-check your medical coverage insurance. Speak with your doctor or the hospital if there are issues, and request a reduction in the payment or ask about available payment plans. The hospital may be willing to work with you, especially if you can demonstrate financial hardship. Generally, as long as you pay monthly, the hospital will not send your bills to the creditors. 

3. Consider payment plan options

Many families pay back their hospital bills with payment plans. If you can't pay your bill in full, ask about payment plan options. Negotiate a monthly payment amount that fits your budget and determine if interest will be charged on the payment plan. Call the hospital or billing department and explain your financial situation and any insurance coverage you have. Ask for an itemized bill so you can review the charges in detail and find out if there are any interest payments. 

Follow these four steps: 

  1. Ask about payment plan options 
  2. Negotiate a monthly payment amount that fits your budget
  3. Determine if interest will be charged on the payment plan and how much
  4. Make sure to stay current on payments to avoid additional fees or penalties
  5. Contact the billing department if you get behind in payments

Caregivers may have additional steps to negotiate a care recipient's emergency room bills. Consider seeking help from a patient advocate or financial counselor to help you navigate your payment options and negotiate. They will help you find the best payment plan for you or your loved one. 

4. Appeal denied claims

If your insurance company denied coverage, file an appeal and provide documentation to support your request. Write a letter to your insurance company explaining why you believe the claim should be covered and include any supporting documentation. The first step is to review your insurance policy and understand your coverage, deductibles, and co-pays. Follow up with the insurance company to confirm your appeal is being reviewed promptly. Remember, persistence and documentation are key when appealing an insurance denial for an emergency room bill. 

5. Seek help from a patient advocate

If negotiating your bill is overwhelming, consider hiring a patient advocate to negotiate on your behalf. They can review your bill, negotiate with the hospital or billing department, and help you navigate the healthcare system. You don't need to navigate this process alone. Caregivers can benefit from having a patient advocate help them negotiate emergency room bills, and their expertise and insight will help you navigate these difficult steps. 

To find a patient advocate, research local healthcare advocacy organizations and ask for referrals from friends or family members. Ask about their services, experience, and fees, and determine if their expertise aligns with your needs. Working with a patient advocate can provide valuable support and guidance as you navigate the complex healthcare system and seek to reduce your emergency room bill.

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Alternatives to ER care

Several alternatives to emergency room care can be more appropriate and cost-effective for patients with non-life-threatening medical conditions. Here are some options:

  1. Urgent Care Centers: Urgent care centers provide medical care for minor to moderate illnesses and injuries like flu, cuts, and fractures. They offer extended hours and walk-in appointments and are typically less expensive than an ER visit.
  2. Telemedicine: Telemedicine allows patients to consult with a healthcare provider via phone or video conferencing. It's a convenient and cost-effective option for patients with minor ailments or needing medical advice.
  3. Retail Clinics: Retail clinics are located in pharmacies or supermarkets and provide basic medical services such as vaccinations, physical exams, and treatment for minor illnesses. They are usually less expensive than an ER visit and offer convenient access.
  4. Primary Care Physicians: Patients can schedule appointments with their primary care physician for non-life-threatening conditions. This option can be more cost-effective, and patients can develop a long-term relationship with their doctor.

It's important to note that you should seek emergency medical care immediately if you have a life-threatening condition or severe symptoms.

 Charitable hospitals

Charitable hospitals are non-profit hospitals that provide care to patients regardless of their ability to pay. They typically offer a wide range of medical services, including emergency care, and often have financial assistance programs available for patients who cannot afford their medical bills.

Charitable hospitals are an essential part of the healthcare system in the United States, as they serve a vital role in providing care to underserved communities and vulnerable populations. Many of these hospitals are also affiliated with academic medical centers and research institutions, which allows them to offer advanced medical treatments and services to their patients.

It's important to note that while charitable hospitals may offer emergency care, patients should still be aware of their insurance coverage and financial obligations. Some hospitals may still require patients to pay for a portion of their medical bills, even if they qualify for financial assistance programs.

Use an online search, local resources, or your insurance provider to find a charitable hospital in your area. Once you have a list of charitable hospitals in your area, it's important to research each hospital's financial assistance policies, including eligibility requirements and the application process. You can also contact the hospital to inquire about their services and financial assistance programs.

A note from Givers

If you're struggling to afford your emergency room bill, don't panic. There are options available to you. Follow the steps outlined above to negotiate an affordable payment plan. It's vital to be proactive and persistent in negotiating healthcare bills, and don't hesitate to reach out for assistance if needed. A patient advocate can be a helpful ally. Remember, you have options and resources to help you and your loved one.

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