Emergency Room Financial Survival Guide

Visits to emergency rooms can be very expensive. There are actions you can take before, during, and after an ER visit to help ease the financial pain.

BEFORE AN ER VISIT

While no one can predict when health-related emergencies will occur, it is wise to prepare for them BEFORE they occur:

  • Understand your health insurance with regard to ER visits. There is a wide variation in coverage levels. If you are unsure about your coverage, you should contact your health insurance provider.
  • Research the emergency rooms in your area. Google, Yelp, Angie’s List, and the BBB all provide customer ratings and reviews. However, be very suspicious if you notice many totally positive reviews (along with many totally negative reviews) since some unscrupulous ERs may be paying for those positive reviews.
  • Contact the ERs in your area and ask for their fee structure (e.g. their facility and doctor’s fees per severity level). This may seem like an odd thing to do, but wouldn’t you rather know these fees BEFORE an emergency (as opposed to when the bill comes)? There can be a huge difference in fees between ERs.

DURING AN ER VISIT

When you must go to an ER, consider the following suggestions:

  • Assuming you are physically able, ask for the ER’s cost structure BEFORE being admitted. Of course, they won’t know all costs up-front, but they should know the basics, such as the ‘facility fee’ and doctor’s fee that you will be billed based on their assessment of the severity level. Be insistent. Even in an emergency, you are the customer and you have the right to know what they are going to charge you before any service is rendered.
  • Take notes, or have a friend or family member do so. Record dates/times, names of the physician(s) and nurse(s), your (or your family member’s) symptoms and diagnoses, both recommended and performed tests and procedures (and the reasoning behind these), and any other pertinent details.
  • If/when the ER staff recommend ANY tests or procedures, ask how much they are going to cost BEFORE agreeing to have those procedures performed. Again, be insistent! It is your right to know prices beforehand and choose what they do to you.
  • Before leaving, ask for the severity level at which you were assessed. If you disagree, try to discuss this with them then and there. Take notes, perhaps even record the discussion. You may need this information later if/when you dispute the bill(s). There can be thousands of dollars difference in your charges based on their assessment of your severity level.

AFTER AN ER VISIT

If you have already gone to a UCHealth (or other) ER, consider the following advice:

  1. Wait for all bills to arrive. Do not pay any bills as soon as they arrive. Check with the ER AND your insurance carrier to verify the number of separate bills. It may take up to 2 months for all bills to arrive.
  2. Request detailed billing statements for bills with questionable charges. This will give you more in-depth information about your charges which you may need later.
  3. If you don’t understand the assessed severity level(s) or any billed amounts, call the provider(s) directly and ask for explanations. Keep detailed records, including dates of calls, names of representatives, and details of the conversations. Do NOT negotiate or discuss payment options at this point.
  4. If you dispute any charges, inform the provider(s) over the phone, but also send letter(s) (preferably via certified mail) to inform them in writing that you formally dispute the charges and why. Their investigation(s) may take 4-6 weeks. You should call them every week or two to check on the status of the investigation.
  5. Call your insurance carrier and notify them of the charges that you dispute and why. In my cases, my insurance carrier was unable to help beyond verifying that the bills were correctly presented by the provider(s) and the amounts that were paid. It is still highly recommended that you inform your insurance carrier about all questionable charges.
  6. Most health insurance companies take fraud very seriously and have compliance and ethics hotlines. If you feel your service provider has over-charged, double-charged, or charged for services not rendered or poorly rendered, you should register a complaint on their compliance and ethics hotline. The compliance and ethics hotline for United Healthcare is: 800-455-4521. You can also register a complaint online here.
  7. While waiting for provider investigations, you may consider other approaches. For UCHealth in particular, you may submit complaints in the following ways (from the UCHealth “Notice of Privacy Practices”):
    • By contacting a UCHealth regional administrative center:
      • UCHealth Central Region – all UCHealth facilities in Denver Metropolitan Area including University of Colorado Hospital and its facilities:
        • 12401 E. 17th Avenue, Aurora, CO 80045, or by phone at 720-848-6215
      • UCHealth South Region – all UCHealth facilities in Colorado Springs and Southern Colorado, including Memorial Hospitals, both Central and North:
        • 1400 E. Boulder Street, Colorado Springs, CO 80909, or by phone at 719-365-5090
      • UCHealth Northern Region – all UCHealth facilities in Northern Colorado or Southern Wyoming, including the Poudre Valley Hospital and Medical Center of the Rockies:
        • 2315 E. Harmony Rd, Suite 200, Fort Collins, CO 80528, or by phone at 970-237-7022
      • Colorado Health Medical Group
        • 2315 E. Harmony Rd, Suite 200, Fort Collins, CO 80528, or by phone at 970-237-7022
    • Complaints may be reported (anonymously if desired) at mycompliancereport.com at this link or by calling 800-403-2511
    • Complaints may be filed (within 180 days) with the U.S. Dept of Health and Human Services Office for Civil Rights in Colorado by sending a letter to 999 18th Street, South Terrace, Suite 417, Denver, CO 80202, or by calling 303-844-7915
    • Complaints may be filed (within 180 days) with the U.S. Dept of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave., S.W., Washington, DC 20201, calling 877-696-6775, or by visiting their website at this link.
  8. Once all provider investigations are completed and the other approaches above do not yield results (and assuming you are still not satisfied), you can try reasoning and/or negotiating with the provider(s).
  9. The remaining choices are to either pay the bill(s), or continue disputing via other means:
  • File a BBB complaint (if you seek an adjustment or settlement) or write a BBB review (if you just want to let others know about your experience). Technically, the BBB does not accept complaints purely about billing issues. Also be aware that the BBB complaint process can take several months, and ultimately the BBB’s decision is not binding. Still, at least writing a BBB review is highly recommended since it will remain on record for 3 years. Note that the parent company of UCHealth is listed by BBB as “aka First Choice Emergency Room” with headquarters at 2941 S Lake Vista Road, Lewisville, TX.
  • Contact a mediation company like Medical Recovery Services to help with negotiations. There may be a fee, and there are no guaranteed results. Still, they are consumer-friendly and knowledgeable about reasonable and customary ER charges and are worth your time to at least call and discuss.
  • Use social media (Facebook/Twitter) to inform your contacts about unsatisfactory ERs. Social media can be a very powerful tool in this regard.
  • Leave reviews for the ER facility and/or doctor(s) on Google, Yelp, and Angie’s List.
  • File complaints about the ER with government agencies that regulate health care. In Colorado, these agencies include:
  • Petition federal, state, and local government representatives for legislation to provide increased consumer protection at ERs. See here for a recommended “Patient’s Bill of Rights”. Colorado Governor and Senators include:
  • Inform local newspapers about ER price gouging. For example:
  • Inform local TV stations about unscrupulous ERs. The full list of Colorado TV stations is here.
  • As a last resort, you may consider taking legal action against the provider(s). A link describing the small claims process in El Paso County is here. Please note that you may have agreed during ER admission to pay for the ER’s legal fees. (This is yet another unscrupulous business practice!) If so, taking legal action (even to small claims court) may get VERY expensive.
  • If you suffered physical harm as a result of going to an ER, particularly if it was due to an unnecessary test or procedure, you may have justification for a malpractice lawsuit against the facility and/or the doctor(s). If this is the case, you should consult an attorney.