Why is the emergency room so expensive?

In my experience, from being on the inside of medical billing, this question was almost always asked; Why is the emergency room so expensive? The answer is simple, but it might make you mad. I totally understand patients that would call and say "Why am I being billed separately when I only visited one place?" or more commonly "A separate bill for the Dr! What Dr! I saw a nurse..."

To answer the question, it is based on a few reasons:

• The emergency room is considered a specialty - that is why you pay a higher co-payment for the ER.
• The hospital charges patients for the use of the facility - even though their bill states the name of the Dr and any other additional service/procedure performed, they are billing for the use of the facility.
• The Dr's bill is for diagnosing - The physician may not come in to see you but the Dr. is looking over your results of all tests done in order to know what to diagnose you with and/or decide for any follow up treatment. This includes the physicians assistant (PA) service that may have treated you in the ER.
• Some hospital's will not staff their emergency room with their own physicians. They will contract an outside recruiting company which places quality physicians to work at their hospitals and that company is responsible for doing their own billing of professional services - hence separate bill. Insurance companies know that an emergency room visit will have separate entities and expect to pay for them separately.
• Medical provider's of service use US Medical Fee's - published yearly, to bill at the rates that they use. It is based on the geographic area. There is no scam to this. The providers may increase their fee's based on this book and it is completely legal. What makes this difficult to understand is when insurance companies tell their members that the provider is billing above and beyond the usual and customary. This may not be the case. If US Medical Fee's changes the rates from one year to another it would not be in the best interest of an insurance company to update their rates. They would much rather deny the claim and that's where the fun begins.

All in all, the service in the emergency room should be worth every cent. Especially in a life or death situation. Perhaps understanding your benefits and knowing when to go to the ER or when to go to an Urgent Care place or even your physician. If you don't have time for an appointment, Urgent Care works best.

I recommend that you find a kind & caring physician, build a healthy relationship with them, update your physician with all and new symptoms and stay in touch. In the event of an ER visit your insurance will not be able to deny your claim because your Dr. found it medically necessary to go to the ER.