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Emergency Room Services and Health Insurance

No one looks forward to having to make a trip to the emergency room. The most important thing you can do to make sure you receive appropriate emergency care as quickly as possible is to purchase medical insurance. Hospitals have different protocols for dealing with insured and uninsured patients. Often times, the uninsured are limited in their use of emergency rooms, and because they are uninsured, they may be unable to see specialists when they’re most needed.

Emergency Room Services for the Insured

When used properly, health insurance can prevent many trips to the Emergency Room. Rather than being forced to make a hasty trip to the hospital because a chronic health condition has flared up, or an ear infection or case of strep throat has become so painful that it must be examined, an insured patient can see their primary care physician for treatment early on and be referred to a specialist if required. This prevents patients from dealing with exacerbating conditions and keeps already overworked Emergency Rooms from filling up with problems that could have, and should have, been avoided.

Most health insurance plans cover trips to the Emergency Room, even if you have managed care insurance and go to a hospital that is out of network. Depending upon your policy, you may be responsible for a co-payment, coinsurance, or deductible. Check your policy to be sure. If you travel out of the country, you will probably require additional travel insurance to cover emergency visits in foreign lands.

Emergency Room Services for the Uninsured

If you don’t have health insurance, you still have certain rights in regards to Emergency Room Services. A 1986 Federal law gives you the right to access emergency services regardless of your ability to pay. Hospitals that participate in Medicare (most U.S. hospitals do), are required to provide “stabilizing care” for a patient that presents with an emergency medical situation. The hospital must provide care without inquiring about your ability to pay.

If you visit an Emergency Room for a condition that is not deemed a medical emergency, the hospital does not have to treat you if you do not have insurance. A situation is considered to be a medical emergency when:

  • The health of an individual, pregnant woman, or unborn child is in serious jeopardy

  • There has been a serious impairment to bodily functions

  • There is a serious dysfunction of a bodily part or organ

  • There is inadequate time to transfer a pregnant woman to another hospital for delivery

  • Transferring poses a threat to the health and safety of a pregnant woman or her unborn child

Also, you may have additional medical rights depending upon the state in which you reside. Despite this, if you were to require an ambulance and you are not insured, the possibility does exist that you will not be taken to the closest hospital, or best hospital, in your area. Additionally, you may incur expensive outpatient and inpatient charges, if such services are required.

Low cost health insurance is a better alternative to being faced with such a situation. If you can’t afford indemnity or managed care insurance, you should at least have catastrophic high deductible coverage. These plans have low monthly premiums. And while you might have to pay a deductible if you are seriously injured, you will get the medical care you need, without having to foot the bill. Many municipalities are now working to offer no-cost and low-cost health insurance to their residents.

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