Controlling Costs: Emergency Room Costs and Usage

Most individuals don’t recognize the emergency room cost they (or their insurer) has to pay for each visit. Does it matter if you end up in an emergency room for a broken bone or if you head to an urgent care center? It does when you factor in the costs of care.

Today’s employers want and expect low premiums for their employees, yet do not recognize the key areas that tend to drive costs upward. When it comes to educating your employees about the services their insurance plan offers, don’t forget to talk about the emergency room cost.

When Is an Emergency Room Best?

Let’s face it, there are times when the ER really is the only option. In any life-threatening situation, from a potential heart attack or stroke to significant bleeding, the emergency response provided in a traditional ER is the only option. There should be no hesitation there. But when it comes to an asthma attack, a broken bone or a fall at work, is the ER really the best place to be?

Consider the Allergic Reaction

An employee has itchy eyes and cannot stop sneezing. They feel miserable. As outlined by Anthem, if they went to the emergency room, they would pay between $150 and $200 for that visit. They pay toward their deductible as well as a copay for care. And, they typically spend about 2 hours and 15 minutes suffering in the waiting room. On the other hand, if they went to the local urgent care or a health clinic available locally, they would like pay between $20 and $75, saving themselves as much as $180. More so, it’s likely they’ll only have to wait for about an hour. Here, it’s clear — urgent care is the better route to take. It saves you money and time, and the care you receive is about the same.

Reduce Your Health Care Costs by Reducing Unnecessary Trips to the ER

Potentially avoidable or low-intensity ER visits are costly to all insurers and that cost can increase your health care premiums. It may seem as though most people recognize when they should go to the ER and when that type of trip isn’t necessary. That’s not the case. In a study conducted by Anthem that looked at 2.1 million unique members, about 82 percent of individual members had one visit to the ER per year that was not considered a necessary trip. About 5 percent of members did this three times, and over a quarter of these visits were for children.

Considering all of this, you may be wondering exactly how you can help educate your employees to prevent this from occurring. There are a few solutions to help keep employees from going to the ER unnecessarily.

Use 24/7 Nursing Lines

Providing members, especially parents, with a 24/7 nursing number to call to inquire about care and whether or not they need to go to the ER, is a critical cost-saving step. It also gives employees a sense of comfort knowing they have a medical professional to talk to at any time.

Teach Them Costs and Tell Them About Their Options

Ensure employees recognize the true cost to the employee, employer and insurer for ER visits. Urgent care visits, which are ideal for conditions that need to be addressed soon and may require X-rays or lab tests, are likely to cost $143, on average. A walk-in doctor’s office visit, best for existing patients with common illnesses, costs about $124. Retail health clinics, best for those who need basic medical care inexpensively, tend to cost about $72. On the other hand, emergency room visits, best left for life-threatening situations, typically cost $1,404, according to Anthem.

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Provide Easy Access to Doctors

Don’t let employees believe their only option for medical care is the ER. Instead, provide them with access to doctor’s visits for preventive care and same-day service. Ensure they have a well-designed and informative website to visit to find a doctor in their area.

The emergency room cost is clear, but so is the access to the medical care your employees need. Help them learn where to get care, how to get it and what it will cost.

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