How to avoid getting stuck with surprise emergency room bills

CR photo

Imagine you're very sick and head to the emergency room, only to later be told by your insurance company that it wasn't a true emergency. Even worse, you're now responsible for the bill.

A new Consumer Reports investigation into surprise medical bills finds more and more patients are getting stuck with big surprise bills from the ER.

Many health insurance company try to discourage costly emergency-room care, by charging a higher copay for ER visits, compared with urgent care centers or walk-in retail clinics.

But some consumers have complained that Anthem has billed for ER visits, saying consumers should have called the company’s 24/7 online doctor service, or gone to their own doctor or urgent care.

Consumer Reports says policies like Anthem’s are leaving consumers with huge medical bills, and could keep patients from going to the ER when they should.

How can you make sure this won’t happen to you? The first step is to understand your insurance.

Check your insurer’s “emergency service benefits” coverage to see how it defines an emergency and what your plan will and won’t cover. While most insurers offer general guidelines as to what constitutes an emergency, they don’t limit policy holders to specific injuries or illnesses. And if you’re insurer rejects a claim, file an appeal.

Anthem told Consumer Reports that it is simply trying to rein in the overuse of emergency rooms for minor problems. The insurer says the ER is a time-consuming and costly place to get care that could be handled elsewhere.

Anthem has many exceptions to its ER policy, such as if a patient is under the age of 15 and was told to go to the ER by his or her doctor.

close video ad
Unmutetoggle ad audio on off