In the United States, an emergency room visit costs $2,200 on average, according to UnitedHealthcare, the largest insurance carrier in the U.S. Since the actual price you pay out of pocket will depend on how severe your condition is as well as what diagnostic tests and treatments you undergo, a visit to the emergency room can sometimes exceed these prices.
A few things to know about how emergency departments determine how much to charge you:
- Total charge = triage fees + facility fees + professional fees + supplies. When you get registered as a patient at the ER, you get charged a triage fee, typically ranging from $200-$1000. Next, when you are assigned into a room, you will incur a facility charge that averages at $1,118, covering your time in the room and nurses' time. Contrary to common beliefs, the attending physician or professional fees are not included within the facility charge and often get billed separately, along with any medications or medical supplies during your visit.
- There are 5 acuities (severity) levels; each has a different charge. Depending on the scale from 1 to 5, if you are a level 3 or above, you may have to wait much longer compared to level 1. If you are level 3 (which is most common), you get charged a lot more than someone who is a level 5.
- If you are eligible for a charity care program, your bill may be reduced. Sometimes hospitals have charity care programs that are income-based. You will get a reduced charge for your ER visits. You can access these programs after your visit by contacting the hospital patient advocacy department.
It is important to determine if your condition is truly emergent or could be treated as lower-cost facilities such as an urgent care center. If you have no insurance or a high deductible and are afraid cost could be an issue, Mira's program could help you access urgent care at a $99 fixed copay that includes all in-house procedures and tests.
Average ER Prices Based on The Types of Treatment
The price of your ER visit will depend on what types of treatments and medications you receive. For patients without health insurance, an emergency room visit can cost less than $2200. If the treatment you receive is extensive, an ER visit can exceed this price. For instance, 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.
Average Cost of Common Conditions Treated
|Common Conditions||Emergency Room Rates|
|Low Back Pain||$751|
|Attention to Dressing/ Removal of Sutures||$343|
Average Cost of Common Services
|Common Service||Emergency Room Rates|
|Broken bones (including surgery)||$10,000|
Below is the average price for an ER visit in each state, from lowest to highest. This is the out-of-pocket cost with no health insurance coverage and for a moderate to severe ER visit.
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Average ER Visit Cost by State
|State||Avg. ER Cost||State||Avg. ER Cost|
|North Dakota||$1,245.00||Rhode Island||$1,750.00|
|North Carolina||$1,589.00||New Jersey||$3,087.00|
Common Reasons For Visiting The ER & Avoidable Visits
People visit the emergency room for various reasons that can be classified according to different levels of care. Outlined below are some of the most common reasons for visiting the ER.
According to research done by NY state, there are 25 conditions that are most common for ER visits. Notice that a large percentage of visits are non-emergent, primary care treatable, or emergent but avoidable. In another research, the state found that more than half of the total 7 million ER visits in 2018 could be treated elsewhere.
- Chest pain: There are many causes of chest pain. However, chest pain can be associated with a heart attack.
- Abdominal pain: If you are experiencing extreme or severe abdominal pain, you may consider going to the emergency room.
- Uncontrolled bleeding: Uncontrolled bleeding is a medical emergency and necessitates an emergency room visit.
- Changes in vision: Changes in vision require professional medical attention that may include an ER visit. Serious underlying medical conditions can cause sudden vision changes, even if the change is temporary.
- Coughing or vomiting blood: This can be serious and requires medical attention.
- Suicidal or homicidal feelings: If you are experiencing suicidal or homicidal thoughts or feelings, you should seek medical attention immediately.
Please note that this list is not comprehensive.
Understanding the Emergency Severity Index (ESI) Scale
Normally, emergency room patients receive one of five levels of care. Level 5 care represents minor problems treated, whereas level 1 care represents some of the most severe treatments an ER can provide. (hence we commonly call an academic medical center a level 1 trauma center). While levels of care exist for even higher and critically ill patients, these levels are used less frequently.
Emergency Room Care Costs by Levels
|ESI 5 (usually diverted to another facility)||Typically a limited, minor problem that will run its course on its own.||$150|
|ESI 4 (longest wait time)||A limited, minor problem with no risk for death and is not likely to permanently alter a patient’s health status.||$400|
|ESI 3 (most common)||A problem where risks are low, and full recovery is expected, but there may be some small risk of problems developing if the patient doesn’t receive treatment.||$650|
|ESI 2||A severe problem that requires urgent evaluation but doesn’t pose a threat to life or physical function; without treatment, there is a high chance of extreme impairment.||$870|
|ESI 1 (ex: ambulance)||An immediate, significant threat to life or physiologic functioning.||$1,450|
Insurance Coverage for ER Visits
The Affordable Care Act (also known as Obamacare) requires all plans to cover emergency services. Under this legislation, insurers cannot charge you more for going to an out-of-network hospital or health care provider. In addition, insurers cannot require you to get pre-authorization before getting service.
Health insurance plans are typically offered in the following categories: Bronze, Silver, Gold, and Platinum. Each plan will provide varied coverage for healthcare bills.
Coverage Percent by ACA Plan Type
Percent insurance covers
Percent you pay
Catastrophic health insurance coverage is also available for individuals under 30 or individuals of any age with a hardship exemption or affordability exemption (based on Marketplace or job-based insurance being unaffordable).
Catastrophic health insurance is a type of health plan that offers coverage in emergencies and coverage for preventive care.
Factors that Contribute to ER Bills
Several factors determine the high costs of ER visits. No sole factor is singularly responsible for the price of an ER visit. Rather, the intermingling of each of these factors contributes to the high costs of an ER visit.
Costs are Determined Based on the Facility and Location
Every emergency room has various costs for supplies and employees depending on:
- The staff they are employing
- The location of the emergency room
- What kind of supplies they're using
Insurance status and categories greatly influence how much the patient has to pay out-of-pocket. For instance, health insurance plans with low monthly premiums may have a cap of around $250 on emergency room expenses. With ER costs ranging from $150-$3000, less extensive insurance plans may only cover the most basic ER visits.
In addition, patients should also note the “in-network” or “out of network" emergency rooms with your insurance plan. Out-of-network ERs will not be covered by your insurance plan and will undoubtedly cost more than in-network ERs.
You should also note that sometimes there are “out of network” doctors working in facilities that are “in-network,” which you might only find out once you get the bill.
Lack of Price Transparency
Emergency rooms do not provide pricing for services upfront. When you seek care at an emergency room, the medical staff will determine your best care plan. Regardless of the services you are provided (stitches, MRI, prescription medication, etc.), it is likely that you will not know the exact cost of services until after your visit.
Running an Emergency Room is Very Expensive
From minor cuts and bruises to MRIs and surgeries, emergencies handle all sorts of medical ailments. Keeping an emergency room open 24/7 with trained and skilled staff has very high costs.
Emergency rooms have to pay for utility bills such as electricity, water, food, and supplies, along with medical care. These costs then get passed to the patients.
Alternatives to the Emergency Room
If you are experiencing a medical emergency that requires immediate attention, you should always seek care from an emergency room.
However, urgent care may be a better alternative if your situation is not severe and does not demand immediate medical attention.
Determining whether to go to urgent care or an emergency room can be unclear. Below are a few medical issues that urgent care clinics can treat:
- Minor fractures
- Back pain
- Nausea, vomiting, and diarrhea
- Minor headaches
- Blood work
- Bumps, cuts, and scrapes
Although going to urgent care is cheaper than the ER, true medical emergencies should always be tended to at an emergency room.
How to Reduce or Dispute an ER Bill
Multiple factors contribute to the costs of surprise medical bills. Among these factors, the two most common reasons surprise bills exist are claim denials and out-of-network providers.
Receiving a surprise medical bill can be scary, but you don’t always have to pay for them in its entirety.
As you can see, a trip to the emergency room can really vary in costs by what you’re going for and how long you end up staying. Plus, if you have health insurance with a deductible that isn’t met or insurance that won’t cover certain costs, then what you’re actually paying can get very complicated.
An easier solution for many things people go to an ER for is Mira, where you can be seen by a local urgent care doctor today for as little as $45 per month and $99 per visit. Learn more about how Mira can simplify your health coverage.