er visit cost with medi cal

How much does an ER visit cost?

$1,500 – $3,000 average cost without insurance (non-life-threatening condition), $0 – $500 average cost with insurance (after meeting deductible).

Average ER visit cost

An ER visit costs $1,500 to $3,000 on average without insurance, with most people spending about $2,100 for an urgent, non-life-threatening health issue. The cost of an emergency room visit depends on the severity of the condition and the tests, treatments, and medications needed to treat it.

Cost data is from research and project costs reported by BetterCare members.

Emergency room visit cost with insurance

The cost of an ER visit for an insured patient varies according to the insurance plan and the nature and severity of their condition. Some plans cover a percentage of the total cost once you meet your deductible, while others charge an average co-pay of $50 to $500 .

The No Surprises Act , effective January 1, 2022, protects insured individuals from unreasonably high medical bills for emergency services received from out-of-network providers at in-network facilities. The act also established a dispute resolution process for both insured and uninsured or self-pay individuals.

Cost of an ER visit without insurance

An ER visit costs $1,500 to $3,000 on average without insurance for non-life-threatening conditions. Costs can reach $20,000+ for critical conditions requiring extensive testing or emergency surgery. Essentially, the more severe your condition or issue, the more you are likely to pay for the ER visit.

Factors that impact ER visit costs

Many factors affect the cost of an ER visit, including:

Facility type – Freestanding emergency departments often cost 50% more than hospital-based emergency rooms.

Time of day – An ER visit at night typically costs more than the same type of visit during the day.

Level of care – The more severe your condition is, the more time and expertise it takes to diagnose and treat, and the higher the total ER visit cost.

Ambulance ride – An ambulance ride costs $500 to $1,300 on average, depending on whether you need basic or advanced life support during transport.

Medications – Oral medications, injections, or IVs needed during your stay all add the total cost of your ER visit.

Medical equipment & supplies – Any other supplies used to diagnose and treat you—such as a cast for a broken bone or bandages and sutures to close an open wound—increase the cost.

Testing – Each medical test is typically a separate charge. Tests may include urine tests, blood tests, X-rays, or other more advanced imaging tests.

Insurance coverage:

Out-of-pocket costs may be higher for those with high-deductible insurance plans.

While ER visit costs are generally higher for the uninsured, many hospitals offer discounts for self-pay patients.

ER facility fee by level

An ER facility fee ranges from $200 to $4,000 , depending on the severity level of your symptoms and condition. The facility fee is the cost to walk in the door and be evaluated by a physician. Other services you may need, such as lab tests, imaging, and surgical procedures, are charged separately.

To understand your ER bill: Emergency rooms rank severity levels 1 through 5, with Level 1 being the most severe or urgent. However, most of the billing codes for emergency room visits are reversed, with level 1 being the least severe.

Common conditions and procedures

The table below shows the average ER visit cost for common ailments. Prices vary greatly depending on how much testing and expertise is required to accurately diagnose and treat you.

Emergency room vs. urgent care

An ER visit costs $1,500 to $3,000 , while the average urgent care visit costs $150 to $250 without insurance. Urgent care facilities can treat most non-life-threatening conditions and typically have less wait time than the ER. For more detail, check out our guide comparing the cost of an emergency room vs. urgent care .

Other alternatives to the ER for less serious health issues include primary care, telemedicine, and free clinics. Check with the National Association of Free and Charitable Clinics to find a free clinic near you.

FAQs about ER visit costs

Why are er visits so expensive.

ER visits are expensive because emergency rooms run on a 24-hour schedule and require a large and wide range of staff, including front desk personnel, maintenance, nurses, doctors, and surgeons. ERs also run and maintain a lot of expensive equipment and need a constant supply of medications and medical supplies.

While ER visits can be expensive, ER bills are negotiable. If you receive an unexpectedly large ER bill, ask for a discount and question the coding.

Does insurance cover ER visits?

Insurance typically covers some or all of an ER visit, though you may need to meet a deductible first, depending on the plan. The Affordable Care Act requires insurance providers to cover ER visits for "emergency medical conditions" without prior authorization and regardless of whether they are in or out-of-network.

An "emergency medical condition" is considered something so severe that a reasonable person would seek help right away to avoid serious harm.

When should you go to the ER?

You should go to the ER for any serious, potentially life-threatening symptoms, including:

Trouble breathing

Serious head injury

Sudden severe pain

Severe burn

Severe allergic reaction

Major broken bones

Uncontrollable bleeding

Suddenly feeling weak or unable to move, speak, or walk

Sudden change in vision

Sudden confusion

Fever that does not resolve with over-the-counter medicine

Tips to reduce your ER bill

An ER visit can cost thousands of dollars, even if you have insurance. Here are some guidelines to ensure you are not overpaying:

Determine if you truly need an emergency room. If your health issue is not life threatening, consider going to an urgent care facility instead as the cost for the same care can be much less.

Go to a hospital-based ER. Freestanding ER centers typically cost much more than a hospital-based emergency room.

Call ahead to confirm payment options and the current wait time.

Ask about costs up front. If you are uninsured, consider asking the following questions to prevent you from surprises on your future bill:

Do you have discounted pricing for patients without insurance?

Will it cost less if I pay with cash?

What will the fee be for my specific issue?

Do you think I will need additional tests, and what will they cost?

How much do you charge for X-rays?

If I need medication, how much will it cost?

We use our proprietary database of project costs, personally contact industry experts to compile up-to-date pricing and insights, and conduct in-depth research to ensure accuracy in all our guides.

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What is a medical emergency?

A  medical emergency  is a medical condition with symptoms such as severe pain or serious injury. The condition is so serious that, if it doesn't get immediate medical attention, you or any prudent layperson with an average knowledge of health and medicine could expect it to result in:

• Placing the person's health in serious risk;  or
• Serious harm to bodily functions;  or
• Serious dysfunction of any bodily organ or part;  or
• There is not enough time to safely transfer the member to another hospital before delivery.
• The transfer may pose a threat to the health or safety of the member or unborn child.

What should you do if you have a medical emergency?

If you have a medical emergency:

• Get help as fast as possible.  Call 911 or go to the nearest emergency room or hospital. Call for an ambulance if you need it. You do not need to get approval or a referral first from your PCP.
• As soon as possible, make sure that our plan has been told about your emergency.  We need to follow up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours. Contact Member Services at 1-855-464-3571 (TTY: 711) for Los Angeles County and 1-855-464-3572 (TTY: 711) for San Diego County. Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you can leave a message. Your call will be returned within the next business day. The call is free.

What is covered if you have a medical emergency?

You may get covered emergency care whenever you need it, anywhere in the United States or its territories. If you need an ambulance to get to the emergency room, our plan covers that. To learn more, see the Benefits Chart in Chapter 4 of the Member Handbook.

For members enrolled in Los Angeles County, you may get covered emergency medical care outside the United States. This benefit is limited to $50,000 per year. For more information, see “Worldwide Emergency/Urgent Coverage” in the Benefits Chart in Chapter 4 of the Member Handbook.

For members enrolled in San Diego County, coverage is limited to the United States and its territories: the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.

There are some exceptions under Medicare as follows:

There are three situations when Medicare may pay for certain types of health care services you get in a foreign hospital (a hospital outside the U.S.):

• You're in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your illness or injury. 
• You're traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. Medicare determines what qualifies as "without unreasonable delay" on a case-by-case basis. 
• You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it's an emergency. In these situations, Medicare will pay only for the Medicare-covered services you get in a foreign hospital.

Medi-Cal coverage is limited to the United States and its territories, except for Emergency Services requiring hospitalization in Canada or Mexico.

After the emergency is over, you may need follow-up care to be sure you get better. Your follow-up care will be covered by us. If you get your emergency care from out-of-network providers, we will try to get network providers to take over your care as soon as possible.

What if it wasn't a medical emergency after all?

Sometimes it can be hard to know if you have a medical emergency. You might go in for emergency care and have the doctor say it wasn't really a medical emergency. As long as you reasonably thought your health was in serious danger, we will cover your care.

However, after the doctor says it was  not  an emergency, we will cover your additional care  only  if:

• You go to a network provider,  or
• The additional care you get is considered "urgently needed care" and you follow the rules for getting this care. (See the next section.)

Getting urgently needed care

What is urgently needed care.

Urgently needed care  is care you get for a sudden illness, injury, or condition that isn't an emergency but needs care right away. For example, you might have a flare-up of an existing condition and need to have it treated.

Getting urgently needed care when you are in the plan's service area

In most situations, we will cover urgently needed care  only  if:

• You get this care from a network provider,  and
• You follow the other rules described in this chapter.

However, if you can't get to a network provider, we will cover urgently needed care you get from an out-of-network provider.

In serious emergency situations: Call "911" or go to the nearest hospital.

If your situation is not so severe: Call your PCP or Medical Group or, if you cannot call them or you need medical care right away, go to the nearest medical center, urgent care center, or hospital.

If you are unsure of whether an emergency medical condition exists, you may call your Medical Group or PCP for help.

Your Medical Group is available 24 hours a day, seven days a week, to respond to your phone calls regarding medical care that you believe is needed immediately. They will evaluate your situation and give you directions about where to go for the care you need.

If you are not sure whether you have an emergency or require urgent care, please contact a clinician by calling our Nurse Advice Line, 24 hours a day, 7 days a week at: 

• Los Angeles County: 1-855-464-3571 (TTY: 711)
• San Diego County: 1-855-464-3572 (TTY: 711)

Getting urgently needed care when you are outside the plan's service area

When you are outside the service area, you might not be able to get care from a network provider. In that case, our plan will cover urgently needed care you get from any provider.

For members enrolled in Los Angeles County , urgently needed services received outside of the United States may be considered an emergency under the worldwide emergency/urgent coverage benefit. For more information, see “Worldwide Emergency/Urgent Coverage” in the Benefits Chart in Chapter 4 of the Member Handbook.

For members enrolled in San Diego, our plan does not cover urgently needed care or any other care that you get outside the United States.

Out-of-Network Coverage

In most cases, you must receive your care from a Health Net Cal MediConnect provider. There are some exceptions, however, when care you receive from an out-of-network provider will be covered. Those exceptions are:

• Emergency care or urgently needed care that you get from an out-of-network provider
• If you need care that cannot be adequately provided by a network provider, including need for continuity of care, you can get this care from an out-of-network provider.
• Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area
• The plan covers out-of-network care in unusual circumstances, so long as those services are authorized in advance by your primary care provider or Health Net Cal MediConnect. Please remember that without that authorization, you will be responsible for payment of the service.

 Examples of unusual circumstances that may lead to out-of-network care are:

• You have a unique medical condition and the services are not available from network providers.
• Services are available in-network but are not available as soon as you need them
• Your primary care provider determines that a non-network provider can best provide the service.

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How Much Does an ER Visit Cost? Free Local Cost Calculator 

It’s true that you can’t plan for a medical emergency, but that doesn’t mean you have to be surprised when it’s time to pay your hospital bill. In 2021, the U.S. government enacted price transparency rules for hospitals in order to demystify health care costs. That means it should be easier to get answers to questions like how much an ER visit costs.

While the question seems pretty straightforward, the answer is more complicated. Your cost will vary based on factors such as if you’re insured, whether you’ve met your deductible, the type of plan you have, and what your plan covers. 

There is a lot to consider. This guide will take you through specific scenarios and answer questions about insurance plans, deductibles, co-payments, and discuss scenarios such as how much it costs if you go to the ER when it isn’t an emergency. 

You’ll learn a few industry secrets too. Did you know that if you don’t have insurance you might see a higher bill? According to the Wall Street Journal , it’s common for hospitals to charge uninsured and self-pay patients higher rates than insured patients for the same services. So, where can you go if you can’t afford to go to the ER?

Keep reading for all this plus real-life examples and cost-saving tips.

How Much Does an ER Visit Cost Without Insurance?

Everything is more expensive in the ER. According to UnitedHealth, a trip to the emergency department can cost 12 times more than a typical doctor’s office visit. The average ER visit is $2,200, and doesn’t include procedures or medications. 

If you want to get a better idea of what an ER visit will cost in your area, check out our medical price comparison tool that analyzes data from thousands of hospitals.

Compare Procedure Costs Near You

Other out-of-pocket expenses you may incur include bills from third parties. A growing number of emergency departments in the United States have become business entities separate from the hospital. So, third-party providers may bill you too, like:

• EMS services, like an ambulance or helicopter 
• ER physicians
• Attending physician
• Consulting physicians
• Advanced practice nurses (CRNA, NP)
• Physician assistants (PA)
• Physical therapists (PT)

And if your insurance company fails to pay, you may have to pay these expenses out-of-pocket.

How Much Does an ER Visit Cost With Insurance? 

The easiest way to estimate out-of-pocket expenses for an ER visit (or any other health care service) is to read your insurance policy. You’ll want to look for information around these terms:

• Deductible: The amount you have to pay out-of-pocket before your insurance kicks in . 
• Copay: A set fee you pay upfront before a covered medical service or procedure. 
• Coinsurance: The percentage you pay for a service or a procedure once you’ve met the deductible.
• Out-of-pocket maximum: The most you will pay for covered services in a rolling year. Once met, your insurance company will pay 100% of covered expenses for the rest of the year. 

Closely related to out-of-pocket expenses like deductibles and co-insurance are premiums. A premium is the monthly fee you (or your sponsor) pay to the insurance company for coverage. If you pay a higher premium, you’ll have a lower deductible and fewer out-of-pocket costs whenever you use your insurance to pay for services such as a visit to the ER. The opposite is also true — high deductible health plans (HDHP) offer lower monthly payments but much higher deductibles. 

Sample ER Visit Cost

Using a few examples from plans available on the Marketplace on Healthcare.gov (current as of November 2021), here’s how this might play out in real life:

Rob is a young, healthy, single guy. He knows he needs health insurance but he feels reasonably sure that the only time he’d ever use it is in case of an emergency. Here’s the plan he chooses:

Plan: Blue Cross/Blue Shield Bronze Monthly premium: $394 Deductible: $7,000 Out-of-pocket maximum: $7,000 ER coverage: 100% after meeting the deductible

Rob does the math and considers the worst case scenario. If he does go to the ER, he’ll pay full price if he hasn’t yet met his deductible. But since both his deductible and his maximum out-of-pocket are the same, $7,000 is the most he’ll have to pay before his insurance kicks in at 100%.

Now imagine that Rob gets married and is about to start a family. He might need a different insurance plan to account for more hospital bills, doctors appointments, and inevitable emergency room visits.

Since Rob knows he’ll be using his insurance more often, he picks a plan with a lower deductible that covers more things. 

Plan: Bright HealthCare Gold Monthly premium: $643 Deductible: $0 Out-of-pocket maximum: $6,500 ER coverage: $500 Vision: $0 Generic prescription: $0 Primary care: $0 Specialist: $40

This time Rob goes with a zero deductible plan with a higher monthly premium. It’s more out-of-pocket each month, but since his plan covers doctor’s visits, prescription drugs, and vision, he feels more prepared as his lifestyle shifts into family mode. 

If he has to go to the ER for any reason, all he’ll pay is $500 and his insurance pays the rest. And worse case scenario, the most he’ll pay out-of-pocket in a year is $6,500. 

How Much Does an ER Visit Cost if You Have Medicare?

Medicare Part A only covers an emergency room visit if you’re admitted to the hospital. Medicare Part B covers 100% of most ER costs for most injuries, or if you become suddenly ill. Unlike private insurance and insurance purchased on the Affordable Care Act (ACA) Marketplace, Medicare rarely covers ER visits that happen while you’re outside of the United States.

To learn more, read: How to Use the Healthcare Marketplace to Buy Insurance

How Much Does an ER Visit Cost for Non-Emergencies?

When you have a sick child but lack insurance, haven’t met your deductible, or if you’re between paychecks, just knowing you can go to the ER without being hassled for money feels like such a relief. ER staff won’t demand payment upfront, and they usually don’t ask about insurance or assess your ability to pay until after discharge.

There are other reasons, too. You might be tempted to go to the ER for situations that are less than emergent because emergency departments provide easy access to health services 24/7, including holidays and the odd hours when your primary care physician isn’t available. If you’re one of the 61 million Americans who are uninsured or underinsured , you might go to the ER because you don’t know where else to go.

What you may not understand is the cost of an ER visit without insurance can total thousands of dollars. Consumers with ER bills that get sent to collections face some of the most aggressive debt collection practices of any industry. Collection accounts and charge-offs could affect your credit score for the better part of a decade.

Did you know that charges begin racking up as soon as you give the clerk your name and Social Security number? There are tons of horror stories out there about people receiving medical bills after waiting, some for many hours, and leaving without treatment. 

4 ER Alternatives Ranked by Level of Care

First and foremost, if you’re experiencing a medical emergency, call 911 or go to the closest emergency room. Do not rely on this or any other website for advice or communication. 

If you’re not sure whether your condition warrants immediate, high-level emergency care, you can always call your local ER and ask to speak to their triage nurse. They can quickly assess how urgent the situation is. 

If you are looking for a lower-cost alternative to the ER, this list provides a few options. Each option is ranked by their ability to provide you with a certain level of care from emergent care to the lowest level, which is similar to the routine care you would receive at a doctor’s office. 

1. Charitable Hospitals  

There are around 1,400 charity hospitals , clinics, and pharmacies dedicated to serving low-income families, including the uninsured. Most charitable, not-for-profit medical centers provide emergency room services, making it a good option if you’re uninsured and worried about accruing substantial medical debt. 

ERs at charitable hospitals provide the same type of medical care for conditions like trauma, broken bones, and life-threatening issues like chest pain and difficulty breathing. The major difference is the price tag. Emergency room fees at a charity hospital are usually flexible and almost always based on your income. 

2. Urgent Care Centers

Urgent care centers are free-standing facilities designed to treat patients with serious but not life-threatening conditions. Also called “doc in a box,” these ambulatory care centers are a good choice for treating stable but chronic health issues, fever, urinary tract infections, back pain, abdominal pain, and moderately high blood pressure, to name a few. 

Urgent care clinics usually have a medical doctor on-site. Some clinics offer point-of-care diagnostic tests like ultrasound and X-rays, as well as basic lab work. The average cost for an urgent care visit is around $180, according to UnitedHealth.

3. Retail Health Clinics

You may have noticed small retail health clinics (RHC) popping up in national drugstore chains like CVS, Walgreens, and in big-box stores like Target and Walmart. The Little Clinic is an example of an RHC that offers walk-in health care services at 190 supermarkets across the United States. 

RHCs help low-acuity patients with minor medical problems like sore throat, cough, flu-like symptoms, and other conditions normally treated in a doctor’s office. If you think you’ll need lab tests or other procedures, an RHC may not be the best choice. Data from UnitedHealth puts the average cost for an RHC visit at $100.

4. Telehealth Visits

Telehealth, in some form, has been around for decades. Until recently, it was mostly used to provide access to care for patients living in the most remote or rural areas. Since 2020, telehealth visits over the phone, via chat, or through videoconferencing have become a legitimate and extremely cost-effective alternative to in-person office visits. 

Telehealth is perfect for some types of mental health therapies, follow-up appointments, and triage. For self-pay, a telehealth visit only costs around $50, according to UnitedHealth.

Tips for Taking Control of Your Health Care

• Don’t procrastinate. Delaying the care you need for too long will end up costing you more in the end. 
• Switch your focus from reactive care to proactive care. Figuring out how to pay for an ER visit is a lot harder (and costlier) than preventing an ER visit in the first place. Data show that preventive health care measures lead to fewer illnesses and better outcomes.
• Plan for the unknown. It’s inevitable that at some point in your life you’ll need health care. Start a savings account fund or better yet, enroll in a health savings account (HSA). If you’re employed (even part-time) you already qualify for an HSA. A contribution of just $9 a paycheck could add up to $468 tax-free dollars for you to spend on health care every year. Unlike the use-it-or-lose-it savings plans of the past, modern plans don’t expire. You can use HSA dollars to pay for out-of-pocket costs like copayments, deductibles, and for services that your health insurance may not cover, like dental and vision services. 
• Advocate for yourself. There is nothing more empowering than taking charge of your health. Shop around for services and compare prices on procedures to make sure you’re getting the best prices possible.
• If you are uninsured or doing self-pay, negotiate your bill and ask for a cash discount. 

Estimate the Cost of the ER Before You Need It

It’s stressful to think about money when you’re facing an emergency. Research the costs of your nearest ER before you actually need to go with Compare.com’s procedure cost comparison tool . 

All you have to do is enter your ZIP code and you’ll immediately see out-of-pocket costs for ER visits at your local emergency rooms. It works for other medical services too, like MRIs, routine screenings, outpatient procedures, and more. Find the treatment you need at a price you can afford.

Disclaimer: Compare.com does not offer medical advice and is in no way a substitute for any medical advice received from health professionals. Compare.com is unable to offer any advice on any medical procedure you may need.

Nick Versaw leads Compare.com's editorial department, where he and his team specialize in crafting helpful, easy-to-understand content about car insurance and other related topics. With nearly a decade of experience writing and editing insurance and personal finance articles, his work has helped readers discover substantial savings on necessary expenses, including insurance, transportation, health care, and more.

As an award-winning writer, Nick has seen his work published in countless renowned publications, such as the Washington Post, Los Angeles Times, and U.S. News & World Report. He graduated with Latin honors from Virginia Commonwealth University, where he earned his Bachelor's Degree in Digital Journalism.

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Medi-Cal Plans

What is medi-cal.

Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources.

Who is eligible?

Some people who apply for Covered California may qualify for Medi-Cal. Eligibility is based on several factors, including:

Collapsible Group Item #1

Collapsible group item #2, collapsible group item #3.

Qualify for Medi-Cal if your income is up to 138 percent of the Federal Poverty Level (FPL) for adults, and up to 266 percent FPL for children. Check Shop and Compare to see if you qualify.

• CalWorks (AFDC)
• Refugee Assistance
• Foster Care or Adoption Assistance Program

Learn more on the Department of Health Care Services website .

• 65 or older
• Residents in skilled nursing or intermediate care homes
• People with refugee status for a limited time
• Parents or caretakers of disadvantaged children under 21
• People who were diagnosed with breast or cervical cancer

How to Get a Health Plan

Depending upon your income, you can get free or low-cost health care through Medi-Cal. Medi-Cal also offers free or affordable programs to start pregnancy coverage right away.

Once you apply for the type of coverage you need with Covered California, you will find out if you are eligible and how the coverage program applies to you.

Medi-Cal Programs

Medi-Cal also offers a mixed-program for families .

Renewing Your Benefits

To keep your Medi-Cal coverage, you’ll have to renew once a year on your original sign-up date. 

When You Report a Change

You must report any household changes within 10 days to your local county social services office.

If you're notified that you no longer qualify for Medi-Cal, call our service center within 60 days to see what your options are with Covered California.

If you're notified that you no longer qualify for Medi-Cal, call our service center within 60 days to see what your options are with Covered California. Contact Us arrow_forward

Find out if you are eligible for Medi-Cal

Need help applying?

You can get help from a certified enrollment counselor right away. It’s always free and confidential. Talk to someone about your options and have them guide you through the process. You can enroll in person, by phone or online.

Help is available in more than a dozen languages.

Is your Medi-Cal coverage ending?

If you got a notice saying you have a new plan through Covered California after losing Medi-Cal, you’ll need to complete enrollment. You can keep, change or cancel this plan now.

Will you be affected by the upcoming changes to Medi-Cal?

• An emergency room visit typically is covered by health insurance. For patients covered by health insurance, out-of-pocket cost for an emergency room visit typically consists of a copay, usually $50-$150 or more, which often is waived if the patient is admitted to the hospital. Depending on the plan, costs might include coinsurance of 10% to 50%.
• For patients without health insurance, an emergency room visit typically costs from $150-$3,000 or more, depending on the severity of the condition and what diagnostic tests and treatment are performed. In some cases, especially where critical care is required and/or a procedure or surgery is performed, the cost could reach $20,000 or more. For example, at Park Nicollet Methodist Hospital in Minnesota, a low-level emergency room visit, such as for a minor laceration, a skin rash or a minor viral infection, costs about $150 ; a moderate-level visit, such as for a urinary tract infection with fever or a head injury without neurological symptoms, about $400 ; and a high-level visit, such as for chest pains that require multiple diagnostic tests or treatments, or severe burns or ingestion of a toxic substance, about $1,000, not including the doctor fees. At Dartmouth-Hitchcock Medical Center[ 1 ] , a low-level emergency room visit costs about $220, including hospital charge and doctor fee, with the uninsured discount, while a moderate-level visit costs about $610 and a high-level visit about $1,400 .
• Services, diagnostic tests and laboratory fees add to the final bill. For example, Wooster Community Hospital, in Ohio, charges about $170 for a simple suture, $200 for a complex suture, about $170 for a minor procedure and about $400 for a major procedure, not including doctor fees, medicine or supplies.
• A doctor fee could add hundreds or thousands of dollars to the final cost. For example, at Grand Lake Health System[ 2 ] in Ohio, an emergency room doctor charges about $100 for basic care, such as a wound recheck or simple laceration repair; about $300 for mid-level care, such as treatment of a simple fracture; about $870 for advanced-level care, such as frequent monitoring of vital signs and ordering multiple diagnostic tests, administering sedation or a blood transfusion for a seriously injured or ill patient; and about $1,450 for critical care, such as major trauma care or major burn care that could include chest tube insertion and management of IV medications and ventilator for a patient with a complex, life-threatening condition. At the Kettering Health Network, in Ohio, a low-level visit costs about $350, a high-level visit costs about $2,000 and critical care costs almost $1,700 for the first hour and $460 for each additional half hour; ER procedures or surgeries cost $460-$2,300 .
• According to the U.S. Agency for Healthcare Research and Quality[ 3 ] the average emergency room expense in 2008 was $1,265 .
• According to the U.S. Centers for Disease Control and Prevention, in 2008, about 18%of emergency room patients waited less than 15 minutes to see a doctor, about 37%waited 15 minutes to an hour, about 15% waited one to two hours, about 5% waited two to three hours, about 2% waited three to four hours, and about 1.5% waited four to six hours.
• In some cases, the doctor might recommend the patient be admitted to the hospital. The American College of Emergency Physicians Foundation offers a guide[ 4 ] on what to expect.
• An ambulance ride typically costs $400-$1,200 or more, depending on the location and services performed.
• An urgent care center offers substantial savings for more minor ailments. DukeHealth.org offers a guide[ 5 ] on when to seek urgent care. An urgent care visit typically costs between 20% and 50% of the cost of an emergency room visit. MainStreetMedica.com offers a cost-comparison tool for common ailments.
• Hospitals often offer discounts of up to 50% or more for self-pay/uninsured emergency room patients. For example, Ventura County Medical Center[ 6 ] in California offers ER visits, including the doctor fee and emergency room fee but not including lab tests, X-rays or procedures, for $150 for patients up to 200% of the federal poverty level, for $225 for patients between 200% and 500% of the federal poverty level and $350 for patients from 500% to 700% of the federal poverty level.
• The American College of Emergency Physicians Foundation offers a primer[ 7 ] on when to go to the emergency room.
• In most cases, it is recommended to go to the nearest emergency room. The U.S. Department of Health and Human Services offers a hospital-comparison tool[ 8 ] that lists hospitals near a chosen zip code.
•   patients.dartmouth-hitchcock.org/billing_questions/out_of_pocket_estimator_dhmc.ht...
•   www.grandlakehealth.org/index.php?option=com_content&view=article&id=106&Itemid=60
•   meps.ahrq.gov/mepsweb/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPS...
•   www.EmergencyCareforYou.org/VitalCareMagazine/ER101/Default.aspx?id=1288
•   www.dukehealth.org/health_library/health_articles/wheretogo
•   resources.vchca.org/documents/SELF%20PAY%20DISCOUNT%20GRID%20-%20BOARD%20LETTER%20...
•   www.EmergencyCareforYou.org/YourHealth/AboutEmergencies/Default.aspx?id=26018
•   www.medicare.gov/hospitalcompare/(S(efntd2saaeir2l5pgarwuvvg))/search.aspx?AspxAut...

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Why An ER Visit Can Cost So Much — Even For Those With Health Insurance

Terry Gross

Vox reporter Sarah Kliff spent over a year reading thousands of ER bills and investigating the reasons behind the costs, including hidden fees, overpriced supplies and out-of-network doctors.

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How Do I Apply?

Applications for the Medi-Cal can be requested by Phone, In-Person, via US Mail or  online .

Did you know that you can apply for Medi-Cal, view documents, submit verifications, report new information and much more using  benefitscal.com ? BenefitsCal is also available on your mobile phone by going to the App Store or Google Play. For faster processing of your application fill out all questions on the application and submit proof of your income.

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Completed Applications can be directed to your nearest Human Services Medi-Cal Office.

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Families of any size are eligible if they meet income guidelines. The following persons may be eligible: 

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Knowing our Rights

If you need information on how to file a Medi-Cal fair hearing, please visit the California Department of Health Care Services Medi-Cal Fair Hearings  webpage or call El Dorado County Health and Human Services at (530) 642-7300 and ask for information on Medi-Cal Fair Hearings. 

For more information regarding your Rights and Responsibilities under the Medi-Cal program, you may also refer to the form MC 219, "What you need to know when you apply for and enroll in Medi-Cal." - ENGLISH (PDF, 210KB)  |  SPANISH (PDF, 284KB)

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Emergency Room Visit: When to Go, What to Expect, Wait Times, and Cost

Knowing when and why to go for an emergency room visit can help you plan for care in the event of a medical emergency.

How much does it cost to go to an emergency room?

Emergency Room (ER) costs can vary greatly depending on what type of medical care you need. How much you pay for the visit depends on your health insurance plan. Most health plans may require you to pay something out-of-pocket for an emergency room visit. A visit to the ER may cost more if you have a High-Deductible Health Plan (HDHP) and you have not met your plan’s annual deductible. HDHP's typically offer lower monthly premiums and higher deductibles than traditional health plans. Your plan will start paying for eligible medical expenses once you’ve met the plan’s annual deductible. Here are some tips to pay less out of pocket .

When should I go to an emergency room?

Emergency rooms are often very busy because many people don’t know what type of care they need, so they immediately go to the ER when they are sick or hurt. You should make an emergency room visit for any condition that’s considered life-threatening.

Life-threatening conditions include, but are not limited to, things like a serious allergic reaction, trouble breathing or speaking, disorientation, a loss of consciousness, or any physical trauma.

If you need to be treated for problems that are considered non-life threatening, such as an earache, fever and flu symptoms, minor animal bites, mild asthma, or a mild urinary tract infection, consider seeing your doctor or visiting an urgent care center or convenience care clinic.

What is the cost of an emergency room visit without insurance?

Emergency room costs with or without health insurance can be very high. If you have health insurance, review your plan documents for details on the costs associated with your plan, including your plan deductible, coinsurance, and copay requirements.

If you don’t have insurance, you may be required to pay the full cost of your treatment, which can vary by facility and the type of treatment required. Always plan ahead for sudden sickness, injury, or other medical needs, so you know where to go and how much it could cost. If you need medical care, but it’s not life-threatening you may not have to go to the ER—there are other more affordable options:

• Urgent care center: Staffed by doctors, nurses, and other medical staff who can treat things like earaches, urinary tract infections, minor cuts, nausea, vomiting, etc. Wait times may be shorter and using an urgent care center could save you hundreds of dollars when compared to an ER.
• Convenience care clinic: Walk-in clinics are typically located in a pharmacy (CVS, Walgreens, etc.) or supermarket/retail store (Target, Walmart, etc.). These clinics are staffed with physician assistants and nurse practitioners who can provide care for minor cold, fever, flu, rashes and bruises, head lice, allergies, sinus/ear infections, urinary tract infections, even flu and shingles shots. No appointments are needed, wait times are usually minimal, and a convenience care clinic costs much less than an ER.

Plan ahead for when you need medical care. You may not need an emergency room visit and the bill that could come with it.

What are common emergency room wait times?

Emergency room wait times vary according to hospital and location. Patients in the ER are seen based on how serious their condition is. This means that the patients with life-threatening conditions are treated first, and those with non-life threatening conditions have to wait.

To help reduce ER wait times, health care facilities encourage you to plan ahead for care, so when you’re sick or hurt, you know if the ER is right for your medical condition.

An emergency room visit can take up time and money if your problem is not life-threatening. Consider other care options, such as an urgent care center, convenience care clinic, your doctor, or a virtual doctor visit (video chat/telehealth)—all of which could be faster and save you money out of your own pocket if the medical problem is non-life threatening.

If you have health insurance, be sure to check your plan documents to see what types of care options are eligible for coverage under your plan, including whether or not you need to stay in your plan’s network.

Is taking an ambulance to the emergency room free?

An ambulance ride is not free, but your insurance may cover some of the costs for the ride, as well as the emergency room visit. Check your plan benefits to see what out-of-pocket expenses you are responsible for when it comes to an ambulance ride and a visit to the ER.

Plan ahead for times you may need immediate medical care. Review the details of your health plan so you know the costs for an ER visit should you ever need it. Know when it’s best to go to the emergency room and when going somewhere else, like an urgent care center, convenience care clinic, your doctor, or even a virtual doctor visit (video chat/telehealth), is the right option that may save you time and money.

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Emergency department visits exceed affordability threshold for many consumers with private insurance

By Hope Schwartz Twitter ,  Matthew Rae Twitter ,  Gary Claxton ,  Dustin Cotliar,  Krutika Amin , and  Cynthia Cox Twitter

December 16, 2022

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Introduction

The high cost of emergency care may impact patients’ ability to afford treatment , with almost half of US adults reporting they have delayed care due to costs. Almost 1 in 10 Americans have medical debt , and about half of American households do not have the liquid assets to afford an average employer sponsored plan deductible. More than one third of US adults are unable to afford a $400 medical expense without borrowing.

Costs of medical emergencies present an additional financial burden on top of already costly health insurance premiums ranging $1,327 for single coverage and $6,106 for family coverage, on average, for workers with employer sponsored insurance. Variation in emergency department billing may make it difficult to predict the cost of an emergency department visit and subsequent financial liability. Recently, the No Surprises Act legislation aimed to curb unexpected emergency medical costs by prohibiting out-of-network billing for emergency services.

In this analysis, we use 2019 insurance claims data from the Merative MarketScan Commercial Database, which captures privately insured individuals with large employer health plans. We look at the total and out-of-pocket costs of emergency department visits for this group, overall and by diagnosis and severity level. We also look at which services contribute most to the costs of emergency department visits and examine regional variation in emergency department costs. Finally, we look at the demographic profile of consumers who visited the emergency department and the relationship between emergency department spending and annual spending for enrollees.

We find that enrollees spend $646 out-of-pocket, on average, for an emergency department visit. Enrollees with high annual health spending were more likely to visit the emergency department; the majority of enrollees in the top 10% of annual health care spending had at least one emergency department visit during the year. The most expensive components of most emergency department visits include evaluation and management charges, imaging, and laboratory studies, and facility fees make up 80% of the cost of visits. Cost varies by disease, visit complexity, and geographic region.

Large employer plan enrollees’ emergency department visits cost $2,453, on average, with enrollees responsible for $646 in out-of-pocket costs

On average, enrollees in large employer health plans who have an emergency department visit spend $646 out-of-pocket on the visit. There is significant variation in emergency department spending, with 25% of visits costing over $907 out-of-pocket and another quarter costing less than $128 out-of-pocket. These out-of-pocket costs for a single emergency department visit may be more than some people with private insurance can afford and, in some cases, could entirely deplete a consumer’s savings. For example, about 1-in-5 people (21%) with private insurance living in single-person households have less than $1,000 in liquid assets.

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How financially vulnerable are people with medical debt?

How does health spending in the U.S. compare to other countries?

These amounts only include out-of-pocket spending required by the insurer. Before the No Surprises Act went into effect in January 2022, privately insured patients who visited the emergency department frequently had out-of-network claims on their visit, putting them at risk of providers sending them surprise balance bills. The No Surprises Act now prohibits most surprise out-of-network billing, but does not apply to ground ambulances . Any balance bill that a patient received from a provider would not appear in claims data and therefore would have been in addition to the out-of-pocket amounts shown here.

In total, enrollees and insurers paid $2,453, on average, per visit, with one quarter of visits costing $970 or less and another quarter costing $3,043 or more. All the costs described in this analysis are for the emergency department visits only, including professional services and facility fees, and do not include any spending on subsequent hospitalizations.

Facility fees contribute significantly more than professional fees to total visit cost

Emergency department bills are categorized as facility fees or professional fees. Professional fees are for services provided by clinicians, and facility fees include bills for services rendered using equipment owned by the facility, including laboratory or imaging studies. These fees are considered “overhead” for emergency departments and help facilities maintain appropriate staffing levels and technical resources. Evaluation and management charges also have a facility fee component for the equipment, staffing, and administrative resources used by the physician in their management. We find that facility fees make up 80% of total visit cost.

Evaluation and management charges make up the largest share of costs

Including both the professional fee and facility fee components of charges, the largest contributor to spending on a typical emergency department visit is the evaluation and management charge, which accounts for almost half (44%) of average visit costs. Evaluation and management charges are bills for the assessment of a patient that are not related to specific procedures or treatments provided; these services cost over $1,100 per visit, on average.

Imaging charges, including radiologist interpretation fees, make up an additional 19% of the average emergency department visit charge and cost $483, on average. The highest cost routinely performed imaging services include x-rays of the chest and CT scans of the head, chest, abdomen, and pelvis. Over half of visits (55%) include a charge for imaging services. About half of patients (49%) are charged for laboratory studies, including blood tests, which cost $230 on average. Other high cost but less common charges include surgical charges for patients with appendicitis and other conditions requiring surgery without inpatient admission, as well as ambulance charges for transport.

Heart attacks and appendicitis among the most expensive common conditions treated in the emergency department

Costs of emergency department visits depend on diagnosis. We selected nine common reasons to visit the emergency department that vary in complexity of management. More severe conditions, or those with more intervention required, are the most expensive. Of the nine specific diagnoses that we evaluated, the lower-cost diagnoses were those that generally do not require imaging or extensive treatment in the emergency department. These included upper respiratory tract infections ($1,535 total, $523 out-of-pocket), skin and soft tissue infections ($2,005 total, $572 out-of-pocket), and urinary tract infections ($2,726 total, $683 out-of-pocket). While these diagnoses can occasionally require admission to the hospital, in otherwise healthy adults they are typically evaluated with basic laboratory studies and discharged with prescriptions.

The most expensive emergency department diagnosis among those we examined is appendicitis, which, on average, costs $9,535 ($1,717 out-of-pocket) per visit. Appendicitis is almost two times as expensive as the next most expensive diagnosis we looked at, heart attack. 11% of enrollees with a diagnosis of appendicitis had surgical charges associated with their emergency department visit. Surgical costs may be included in emergency department outpatient billing because these patients are often discharged after surgery without being admitted to the hospital. In contrast, other emergency department visits requiring surgery are often admitted to the hospital and have surgical charges during their inpatient visit. Enrollees who had surgery had more expensive visits by over $2,000 compared to those who did not; however even without surgery, visits for appendicitis were almost four times as expensive as the average emergency department visit (and more than twice as expensive out-of-pocket).

Enrollees with emergency department visits have variable annual spending depending on diagnosis

In addition to the costs of the emergency department visit itself, enrollees who visit the emergency department at least once during the year have higher annual health care spending. Annual spending includes the cost of all claims for each patient in 2019, either before or after their emergency department visit. Though appendicitis was the most expensive emergency department visit among the diagnoses we analyzed, enrollees with appendicitis in 2019 incurred an average of $24,333 in additional health care spending, which was comparable to lower cost diagnoses. Enrollees with heart attacks had at least two times more annual spending than any other diagnosis ($52,993), while enrollees with upper respiratory tract infections had the lowest annual spending ($13,727).

These differences in annual costs may reflect spending both directly related and unrelated to the emergency department visit. For example, enrollees with heart attack emergency department visits may have high annual spending because of follow-up, medications, or hospitalizations after their heart attacks. However, their high annual spending may also reflect more comorbidities and higher healthcare utilization at baseline. In contrast, appendicitis, the most expensive emergency department visit, is correlated with relatively lower annual costs; unlike heart attacks, appendicitis often occurs in younger, healthier people and requires comparatively little additional post-surgical follow-up or treatment.

The most complex emergency visits are more than 6 times as expensive as the least expensive visits, but insurers pay an increasing share of the visit as complexity increases

Emergency department visits are coded by complexity during the billing process, from 1 (least complex) to 5 (most complex). Each evaluation and management charge is associated with a procedure code ranging from level 1 to level 5 (99281 to 99285), which are generated by hospital coding professionals based on the physicians’ medical note. Criteria are defined by the Centers for Medicare and Medicaid Services ( CMS ) and based on the complexity of documentation and medical decision making. Patients with level 1 complexity codes require straightforward medical decision making, with self-limited or minor presenting problems, such as rashes or medication refills. Patients with level 5 codes require high complexity medical decision making and present with life- or limb-threatening conditions, such as severe infections or cardiac arrests.

The lowest complexity visits cost $592 on average, with enrollees responsible for $205, or about one-third of the total visit cost. As visits increase in complexity, both out-of-pocket costs and costs covered by insurance increase. For the highest complexity visits, the health plan covers $3,015 on average, or eight times the cost of the lowest complexity visits. On average, patients pay $840 out-of-pocket for the highest complexity visits, which is four times their out-of-pocket costs for the lowest complexity visits.

Higher complexity visits are more expensive for multiple reasons. In general, evaluation and management charges are higher cost for more complex patients. Also, patients with more complex medical conditions generally receive more diagnostic tests, medication, and other treatment, which increases the cost of the visit. For the lowest complexity visits, evaluation and management charges account for almost half (47%) of the overall visit cost. In contrast, evaluation and management charges for the highest complexity visits account for about one-fourth (27%) of the total visit cost, with additional services including tests and treatment making up a larger share of the cost.

Emergency department costs vary by geographic region

We analyzed the top 20 metropolitan statistical areas (MSAs) by population, where data are available. Overall, the San Diego, CA area had the most expensive average ED visits ($3,761 on average). San Diego ED visits were more than twice as expensive as Baltimore, MD, the least expensive MSA in our analysis ($1,645 on average). Expensive MSAs were geographically distributed in all regions of the country including the South, West, Northeast, and Midwest. Within each MSA, there was significant variation in visit costa. For example, 25% of visits in Oakland, CA cost less than $1,236 on average, while 25% cost more than $4,436 on average.

Some variation may be based on the distribution of diagnoses in each area, with more serious or complex diagnoses leading to higher cost visits. For example, if a metro area sees higher than average volume of appendicitis, heart attacks, or other high-cost diagnoses, that would drive up regional emergency department costs.

For common diagnoses, Texas and Florida MSAs are among the most expensive

If we examine costs for specific diagnoses, we can minimize some of this variation in reasons for visits and gain a better understanding of how prices and service intensity affect the rankings. We selected two common, moderate-cost reasons for emergency department visits: low back pain and lower respiratory infections. While these visits can range in complexity and treatment required, they usually do not require hospital admission or high-cost treatment. Low back pain includes patients who present with the symptom of low back pain, regardless of diagnosis. Lower respiratory tract infection includes infectious causes of pneumonia and bronchitis. This analysis was limited to MSAs in which there were >500 cases of each diagnosis in 2019.

Visit costs for both diagnoses in Dallas, TX, Houston, TX, Fort Worth, TX, and Orlando, FL are in the top five most expensive MSAs with >500 cases. For low back pain visits, the Orlando, FL, Fort Worth, TX, Dallas, TX, and Houston, TX areas are each more than twice as expensive as the Warren, MI and Detroit, MI areas, on average. This trend is similar for lower respiratory tract infections. Within MSAs, variation in costs exist for both diagnoses. For example, for low back pain visits, there is more than a $3,000 difference between the least expensive and most expensive quarter of visits in Fort Worth, TX, Dallas, TX, and Houston, TX.

12% of large employer group enrollees went to the emergency department in 2019

We find that 12% of large group enrollees under age 65 had at least one emergency department visit in 2019, and of enrollees with emergency department visits, 80% had only one visit. 20% had more than one visit, and 7% had more than two visits. Emergency department visits were associated with higher annual health care spending, with almost half of enrollees in the top 25% of annual spending having at least one emergency department visit during the year.

We find that the average emergency department visit exceeds the threshold that some consumers can pay without borrowing, and even one emergency department visit in a year may create financial hardship for enrollees in large employer plans. For example, one quarter of emergency department visits for large employer enrollees cost over $907 out-of-pocket. Meanwhile, about 1-in-5 people with private insurance do not have $1,000 in liquid assets, and almost half of US adults report that they would not be able to pay a $500 medical bill without going into debt. Emergency department visits range significantly in cost depending on diagnosis, visit complexity, and geographic area. These variations may present challenges for consumers trying to predict the cost of their emergency department visit prior to going to the emergency department.

Several factors contribute to the variability of emergency department charges. First, unlike other forms of outpatient care including primary care or urgent care visits, emergency departments charge facility fees to offset the cost of keeping emergency departments open and staffed 24/7. These fees vary widely and are increasing at a faster rate than overall health care spending. The facility component represented 80% of total emergency department spending in our analysis. Many hospitals and health care providers consider these costs necessary given their mandate to provide emergency triage and treatment to allcomers. A second contributor to variation is that services are often billed at different complexity levels, and visits that are billed as more complex are more expensive . In some cases, even similar services are billed at different prices by different facilities. Notably, surprise out-of-network medical bills from emergency departments have contributed to high emergency costs for consumers, though the cost of any balance bills would be outside the scope of our claims data. The implementation of the No Surprises Act in January 2022 will generally curb surprise medical billing for emergency care.

As seen in non-emergency spending , we find that emergency department costs vary by geographic area. Among the most expensive MSAs in our analysis were MSAs located in Texas, Florida, California, Colorado, and New York. Interestingly, the most expensive regions for ED care do not align with the most expensive regions for overall health care spending. These comparisons suggest that our findings are not solely related to overall high health care prices in these areas and may reflect other factors including the age and medical complexity of the population or differences in local norms and practice patterns. State-level emergency department regulation may also play a role—states with higher numbers of freestanding , non-hospital affiliated emergency departments (which are associated with higher spending on emergency care) were among the most costly in our analysis.

The financial implications of visiting the emergency department vary widely. Not all the variation in total charges is reflected in out-of-pocket costs, since differences in cost by complexity level are smaller after insurance covers its portion of the bill. However, the most complex emergency department visits have four times higher out-of-pocket costs than the least complex visits. Even the least complex visits, some of which could be treated by a primary care office or urgent care center, cost an average of $205 out-of-pocket ($592 total). Given facility fees and relatively high evaluation and management charges in emergency departments, insurers and patients are paying more when receiving care for these conditions at emergency departments than they would using primary or urgent care. These lower complexity visits may represent a substantial avoidable cost to patients and the health care system at large.   

High health care costs are of foremost concern for US adults, leading people to skip recommended medical treatment or delay necessary care. Even in the era of new price transparency regulation , which aims to improve consumer access to prices for elective care, emergency department consumers often do not know what testing or treatment they will need, so it is difficult to assess the costs of a visit upfront. Further, in an emergency situation, patients may not be able to choose their provider or facility if they are brought in by ambulance or otherwise unable to direct their care. Lastly, lack of availability and standardization in data may make it difficult for patients to use price transparency data in real time to make decisions about accepting tests and treatment in an emergency. The high and variable cost of emergency department visits represents an opportunity for future policy changes to protect consumers from unaffordable medical bills.

This analysis is based on data from the Merative MarketScan Commercial Database, which contains claims information provided by a sample of large employer plans. Enrollees in MarketScan claims data were included if they were enrolled for 12 months. This analysis used claims for almost 14 million people representing about 17% of the 85 million people in large group market plans (employers with a thousand or more workers) from 2004-2019. To make MarketScan data representative of large group plans, weights were applied to match counts in the Current Population Survey for enrollees at firms of a thousand or more workers by sex, age, state, and whether the enrollee was a policy holder or dependent.

Emergency department visits were flagged if an enrollee had an emergency department evaluation and management claim in the emergency department or the hospital on a given day. If an enrollee had either an emergency evaluation and management claim or another claim originating in the emergency department on the day prior to or after the flagged day, we added the previous and or following day’s outpatient spending to the visit cost. This was to capture all emergency department services for visits that may have spanned overnight or multiple days. Over half (53%) of the spending in this analysis occurred in the emergency department, with another 42% occurring in the hospital, which may occur when a patient receives a test or procedure in a location outside the emergency department during their visit.

Claims were included if they were above $100 and below the 99.5 th percentile of cost. Selected conditions were generated from a literature review of common emergency department diagnoses and defined using ICD10 codes. Enrollees were considered to have a certain diagnosis if the relevant ICD10 code appeared in the “Diagnosis 1” column in one or more claims on an emergency department visit day. While emergency department claims have up to four diagnoses, diagnoses listed in 2-4 were not used to identify relevant conditions because these diagnoses were most often incidentally found rather than related to the reason for presenting to the emergency department. For specific diagnosis definitions: Heart attack includes acute STEMI and NSTEMI, and excludes complications from prior heart attacks or angina; UTI includes acute cystitis, UTI and pyelonephritis; Kidney stone includes renal calculus in any location and renal colic; Lower respiratory infection includes pneumonia and bronchitis. Surgical charges for acute appendicitis include both open and laparoscopic surgical charges. Annual spending was defined as the total spending for each enrollee in the year 2019, which could occur before and/or after their emergency department visit depending on the time of year of the emergency department visit.

This analysis has some limitations. First, there is a chance that we could incorrectly include non-emergency outpatient care (such as a next-day, follow up primary care appointment) in our estimate of emergency department visit costs. Secondly, when accounting for annual spending, we do not control for health status prior to the emergency department visit. Therefore, the increase in annual health spending for patients who visit the emergency department for certain conditions may be because these patients are sicker and higher healthcare utilizers at baseline, rather than specific follow-up costs incurred for the emergency department visit itself. For selecting relevant diagnoses, we only include claims in which a particular diagnosis occurs as the primary diagnosis. Third, the MarketScan database includes only charges incurred under the enrollees’ plan and do not include balance billing to enrollees which may have occurred. Lastly, our findings only represent enrollees in large group employer sponsored plans and may not be generalizable to other groups.

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Why Did My Emergency Room Visit Cost So Much?

Emergency room visits are notoriously expensive. Just a few hours in the ER can cost you thousands of dollars, with or without insurance.

But how is your ER visit cost calculated, and how can you tell whether your hospital bill is correct? 

We scored some insider tips from Goodbill medical coding expert Christine Fries, who has analyzed thousands of ER hospital bills for accuracy. Here are answers to frequently asked questions we get from Goodbill customers about how to understand and vet ER visit costs.

Why did I get 2 bills for my ER visit?

Patients are usually surprised when their first ER hospital bill is quickly followed by a separate hospital bill with similar-sounding charges but different amounts. This is normal and a byproduct of how hospitals bill patients for the services rendered at the hospital, Fries says. 

The institutional bill, also known as the facility bill, charges you for the procedures, tests, and administrative costs from the hospital. 

The professional bill, also known as the physician bill, charges you for the work and time of the physician who treated you. This generally includes services from doctors, anesthesiologists, or specialists who are affiliated with the hospital but aren’t employed by the hospital. 

Expect to get two bills from your ER visit — one for facility charges, and the other for professional or physician charges.

For more information on the different types of hospital bills, see our itemized bill guide . Goodbill currently helps patients negotiate institutional bills, not professional bills, so our guidance below pertains to institutional bills only. 

My diagnosis turned out to be minor. Why was I charged so much?

It’s important to remember that your ER visit costs are based on the symptoms you first describe upon entering the hospital, not your eventual diagnosis, Fries says.

When a patient walks into the emergency room complaining of chest pains, for example, the hospital’s objective is to run tests and administer procedures that can help rule out life-threatening conditions. Even if the doctor ends up discharging the patient with a non life-threatening diagnosis like indigestion, the hospital has already spent the resources to rule out more severe possibilities like a heart attack.

Your ER visit costs are based on the symptoms you first describe upon entering the hospital, not your eventual diagnosis.

“Look at your symptoms first, not what you were diagnosed with,” Fries says. “The level of your ER visit is guided by the symptoms you described, and by the tests the hospital thought were needed based on those symptoms.”

Why was I charged for an ‘ER Visit Level’ 3, 4, or 5? Is this based on severity?

Hospitals will bill you for a line item called “ER Visit Level” that is based on the complexity of your treatment. ER visit levels range from 1-5: ER visit level 1 is the most mild, while ER visit level 5 is the most severe. The level also determines how much the hospital can charge you, from least expensive to most expensive. You may sometimes hear ER visit levels described by their corresponding Current Procedural Terminology (CPT) codes of 99281, 99282, 99283, 99284 and 99285. 

To decide the proper ER visit level, hospitals typically follow certain guidelines from the American College of Emergency Physicians (ACEP) . ER level 1-2 visits are reserved for treatment of mild cases like bug bites and sunburns. The majority of ER visits fall between ER visit levels 3-5, with ER visit level 4 being the most common, Fries says.

“Most emergency room claims will qualify as a 99284, because you only need something as simple as IV fluids to get you there,” Fries says.

The majority of ER visits fall between ER visit levels 3-5, with ER visit level 4 being the most common.

Here’s a simple rule of thumb for determining whether your ER visit level was correctly assigned.

ER Visit Level 4

‍ An ER visit level 4 typically requires a minimum of two diagnostic tests — like a lab plus an EKG, or a lab plus an X-ray. Or, any administration of fluids through IV will automatically qualify your visit as an ER visit level 4.

ER Visit Level 5

‍ An ER visit level 5 typically requires a minimum of three diagnostic tests — for example, a lab plus EKG and X-ray. Or, any type of imaging scan like a CT scan or MRI where a patient must ingest or be injected with contrast material, will automatically qualify your visit as an ER visit level 5.

‍ I’m not pregnant. Why did I get charged for a pregnancy test?

Many female patients get frustrated when they’re charged for a pregnancy test, even when they’re absolutely certain they’re not pregnant. But this is standard practice and a way for hospitals to protect against unknown pregnancies, Fries says. 

If you’re an adult pre-menopausal female, you can count on being asked to do a urine or blood pregnancy test before the hospital will treat you. It’s too risky to both the patient and hospital to administer injections, scans or drugs in the off chance that a patient is unknowingly pregnant. 

If you're a female, expect to get a pregnancy test during your ER visit — even if you're not pregnant.

On your itemized ER bill, your pregnancy test will usually show up with a description like “human chorionic gonadotropin (hCG),” which is the hormone being tested. This charge will generally fall under the CPT codes 84702 or 84703 if it’s a blood test, or 81025 if it’s a urine test. 

What are some other common ER services I might see on my hospital bill? 

Here are a few common procedure names that often show up in your ER visit costs, and what they mean in plain English:

Metabolic panel

‍ This is a bundle of lab tests run from a single blood draw. Patients may get a “basic” metabolic panel under CPT code 80048, or a “comprehensive” metabolic panel under CPT code 80053. These panels cover a set of individual tests that might otherwise be individually charged. For example, a “comprehensive” metabolic panel must include testing for all of the following: 

• Carbon dioxide
• Phosphatase, alkaline
• Transferase, alanine amino
• Transferase, aspartate amino
• Urea nitrogen

Venipuncture

‍ Any time you get your blood drawn through a needle, this charge under CPT code 36415 is the line item that bills you for the needle.

‍ This test under CPT code 83690 measures your levels of lipase, which is an enzyme that helps break down fat in your intestines. Your lipase levels may be elevated if you have pancreatitis, which is an inflammation of the pancreas gland.  

What are some ER visit cost errors I should look out for?

When analyzing a patient’s ER visit costs for errors, Fries says she goes straight to one place first: Hydration services. If you recall being administered fluids through an IV bag, chances are you got hydration services during your ER visit.

“Hydration services should always be questioned,” Fries says.

Coding guidelines require that the two CPT codes for this service, 96360 and 96361, meet a minimum time requirement of 31 minutes in order for one unit to be billed. These 31 minutes must also be “stand alone” — meaning that the administration of the service cannot overlap with any other type of infusion service. Often, hospitals don’t meet these requirements, rendering the charge unbillable.

Hydration services are a common source of errors in ER hospital visit costs. You can tell if you're being overcharged by checking your medical record.

To verify whether you’re being charged properly, you’ll need your medical record, Fries says. Look for hydration service “start” and “stop” times, which are usually included in the Medication Administration Report (MAR) section of your record. If the hydration service duration is less than 31 minutes of standalone time, you have a strong case to dispute the charge with your hospital. To find out how to get your medical records online, visit our Medical Records guide .

I don’t see any CPT codes on my bill. How can I get them?

CPT codes are the common language used across all hospitals to describe a certain procedure. They’re what enables our medical coders at Goodbill to analyze hospital bills for errors, line item by line item. They also help us compare prices apples-to-apples across hospitals.

CPT codes are the standard language used to describe a certain procedure across all hospitals. They're key to helping you identify errors or inflated charges in your ER hospital bill.

Unfortunately, the hospital bill you get in the mail is most likely a consolidated summary of your ER visit costs and won’t include CPT codes. You’ll need an “itemized bill” from your hospital to get a line-by-line breakdown of each charge, complete with the CPT code and cost. 

The good news is that you’re legally entitled under HIPAA to get access to this information. To learn more about your patient rights and how to obtain your itemized bill, check out our Patient Right of Access guide .

Are there other topics you’d like us to cover? Email us at [email protected] and let us know.

Guides, news, and articles to help you tackle hospital bills.

How to Negotiate Your Hospital Bill

Read our expert tips on how to negotiate your hospital bill to save up to thousands of dollars.

Itemized Bill: Your Key to Negotiating

Itemized bills provide key details that can help you negotiate your hospital bill.

Can Hospital Bills Affect My Credit?

You have time before your bill can go to collections or affect your credit.

Negotiating hospital bills has never been this easy.

Building trust and confidence into every health care transaction.

© 2022  Goodbill, Inc.

ER, urgent care or virtual visit? What to consider to help you save on costs

You slipped on the stairs and feel your ankle throbbing. Or your child spikes a high fever in the middle of the night. You call your primary care doctor first, but you can't get a same-day appointment. So do you go to the emergency room (ER) or urgent care? Or would a virtual visit work best?

If it’s not actually an emergency situation, rushing to the ER  can cost two to three times  more than care in a provider’s office. In addition, seeking care in the ER may mean longer wait times and an increased exposure to germs, plus potentially unnecessary tests or treatments. Using the ER for all your health care needs may also mean you’re missing an opportunity to create a long-term relationship with a primary care provider who can address preventive needs before more serious issues arise.

That’s why understanding the most appropriate care setting is an important step to help you receive the simplest experience for your situation.

Here’s what to consider when deciding where to go for care:

Urgent care center

Urgent care centers are not for emergencies but can help you when you need care quickly. If you can’t get in with your primary care physician, this may be another option. Remember, it’s first-come, first-served. You may consider urgent care if you have symptoms like the following:

• Fever without a rash
• Moderate flu-like symptoms
• Sprains and strains
• Small cuts that may require stiches

The average cost for an  urgent care visit is $185. 1

Emergency room

The hospital emergency room provides medical care for life-threatening injuries or illness. While some people may be tempted to utilize ER services because it’s open 24/7, the wait time is  typically two hours on average , and can vary greatly based on time of day and location. Patients with life-threatening emergencies or critical conditions will be treated first so if you’re experiencing a minor ailment, it may not be the best place to seek care. Some of the symptoms that require an emergency room visit include, but are not limited to:

• Slurred speech
• Serious burns
• Broken bones and dislocated joints
• Fever with a rash

The average cost for an  emergency room visit is $2,600 . 1

Have you considered a virtual visit?

If you are faced with a non-emergency health condition – like a migraine, possible COVID-19, sore throat or stomachache – but your doctor’s office is closed, you may consider a virtual visit. This allows you to virtually chat face-to-face with a doctor, day or night, and may save you up to $1,500 when compared to a visit to the ER. 2

The average cost for a  virtual visit is $54. 1

Still not sure?

UnitedHealthcare plan members can also compare quick care options with UnitedHealthcare’s  online resource , and get more information to help with  COVID-19 concerns . If you or a loved one are experiencing what you feel to be life-threatening symptoms other than those listed, go to the emergency room or call 9-1-1.

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Emergency department services

Medicare Part B (Medical Insurance)  usually covers emergency department services when you have an injury, a sudden illness, or an illness that quickly gets much worse.

Your costs in Original Medicare

• You pay a  copayment for each emergency department visit and a copayment for each hospital service you get.
• After you meet the Part B deductible , you also pay 20% of the  Medicare-Approved Amount  for your doctor's services.
• If your doctor admits you to the same hospital for a related condition within 3 days of your emergency department visit, you don't pay the copayment(s) because your visit is considered part of your inpatient stay.   

Find out cost

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Things to know

Medicare only covers emergency services in foreign countries under rare circumstances.

Related resources

• Ambulance services
• Find hospitals
• Inpatient hospital care
• Outpatient hospital services

Is my test, item, or service covered?

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The Protesters and the President

Over the past week, thousands of students protesting the war in gaza have been arrested..

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Featuring Jonathan Wolfe and Peter Baker

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Over the past week, students at dozens of universities held demonstrations, set up encampments and, at times, seized academic buildings. In response, administrators at many of those colleges decided to crack down and called in the local police to detain and arrest demonstrators.

As of Thursday, the police had arrested 2,000 people across more than 40 campuses, a situation so startling that President Biden could no longer ignore it.

Jonathan Wolfe, who has been covering the student protests for The Times, and Peter Baker, the chief White House correspondent, discuss the history-making week.

On today’s episode

Jonathan Wolfe , a senior staff editor on the newsletters team at The New York Times.

Peter Baker , the chief White House correspondent for The New York Times covering President Biden and his administration.

Background reading

As crews cleared the remnants of an encampment at U.C.L.A., students and faculty members wondered how the university could have handled protests over the war in Gaza so badly .

Biden denounced violence on campus , breaking his silence after a rash of arrests.

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The Daily is made by Rachel Quester, Lynsea Garrison, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, M.J. Davis Lin, Dan Powell, Sydney Harper, Mike Benoist, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Diana Nguyen, Marion Lozano, Corey Schreppel, Rob Szypko, Elisheba Ittoop, Mooj Zadie, Patricia Willens, Rowan Niemisto, Jody Becker, Rikki Novetsky, John Ketchum, Nina Feldman, Will Reid, Carlos Prieto, Ben Calhoun, Susan Lee, Lexie Diao, Mary Wilson, Alex Stern, Dan Farrell, Sophia Lanman, Shannon Lin, Diane Wong, Devon Taylor, Alyssa Moxley, Summer Thomad, Olivia Natt, Daniel Ramirez and Brendan Klinkenberg.

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Jonathan Wolfe is a senior staff editor on the newsletters team at The Times. More about Jonathan Wolfe

Peter Baker is the chief White House correspondent for The Times. He has covered the last five presidents and sometimes writes analytical pieces that place presidents and their administrations in a larger context and historical framework. More about Peter Baker

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