I get many calls from customers carefully reading fine print on policies asking about special deductibles for emergency rooms and limitations for emergency room coverage for persons not admitted into the hospital. To those customers, I would firstly say: Good job!! Reading the fine print is a very good idea and understanding it even better. So I do not mind these calls in the least. It shows a very savvy consumer and I am more than happy to assist them in understanding these insurance terms and definitions.
The issue is quite simply this: Emergency room costs in the US are ridiculously high. A quick stay in one can cost over $1,000 without needing much in the way of medical care. It is because of this that insurers want to protect themselves from these costs (understandable, but it does tend to make some customers a bit nervous which is likewise understandable). Here’s the deal: if you are not in peril for your life, DON’T go to the emergency room. There are many somewhat new medical facilities called “Urgent Care Centers” all over the US. This should be your first go-to in case of sudden medical issue (not life threatening) during hours that a doctor’s office is not open or you cannot get a timely appointment.
So, when my kid has a bad ear ache and I know it won’t wait until Monday morning, this is where I go. If I suspect I have a bladder infection at 6pm Friday night, this is where I go. Admittedly, you may not know how badly off you or your visitor is when you seek treatment. Certainly, the medical professionals at an urgent care facility will be able to call and direct you to a hospital/ambulance should the need arise. Furthermore, you or your visitor can receive medical care up until the moment the ambulance arrives.
Limitations on coverage are waived in the case of an injury. So, if someone is badly cut, for example, and they stitch them up in the ER and then release them, you will NOT be subject to limitations in coverage. It’s only in the case of sickness that coverage might not be there for a person who is not fully admitted into the hospital after being seen in the ER.
Now, to be clear, no one is expecting you to risk your traveler’s life. If a heart condition or something more critical may be going on, by all means call an ambulance and get to an ER as soon as may be as time is clearly of the essence. However, you should just be aware of these other medical facilities which often have triage units and can handle a more minor emergency possibly with less waiting time and less cost (to you and the insurance company).
As always, we wish you safe and happy travels wherever you may go!