Does Health Insurance Always Cover Emergency Room Visits?

Emergency room (ER) visits can get very expensive, very quickly. For those who have health insurance, an ER visit will be covered by your insurance in most cases. In some instances, like for the treatment of minor illnesses, you may be responsible for the out-of-pocket costs. Some emergencies can be treated at urgent care facilities instead of ERs to save money, such as sprains and stitches.

With a Mira membership, you can get access to low-cost urgent care visits to save you even more money. In addition, members get low-cost virtual care, up to 80 percent off over 1000 different prescription medications, and same-day lab testing, for an average of $25 a month. Why spend when you could save? Sign up for Mira today. 

Does Health Insurance Always Cover Emergency Room Visits?

In general, health insurance companies will cover the cost of a visit to the emergency room (ER). The Affordable Care Act (ACA) requires companies to cover emergency services, as it is considered an essential health benefit. Your visit to the ER must be deemed an emergency, which is defined as a sudden life-threatening injury or illness that requires immediate medical attention. This may include situations like:

• Stroke
• Heart attack
• Severe burns
• Seizure
• Severe bleeding
• Unconsciousness

You are able to visit an emergency room in any situation that you see fit. Depending on the type of insurance plan you have, you may need to pay a deductible before the company begins covering the cost. 

However, you should note that treatment for minor illnesses, may not be considered an emergency service, and may result in you covering the out-of-pocket expenses. In addition, visiting the ER when you don’t necessarily need to may be a waste of your time. People who have more severe conditions are likely to be seen quicker. 

These policies apply to most major medical insurance companies, including Medicare and Medicaid. Another aspect of ACA (or Obamacare) is that insurance cannot charge you more for seeing an out-of-network provider or visiting an out-of-network facility. They are required to charge you the same coinsurance or copayment regardless of where you go. In addition, your insurance provider cannot force you to get pre-authorization before visiting the ER.