What Happens if I Go to the E.R. Without Insurance?

An emergency room (ER) visit can cost up to $2,600 if you don’t have insurance. With insurance, the average cost decreases to $1,150.

Keep reading to learn more about what goes into how much is an emergency room visit without insurance. We also share tips on ways to lower your ER bill and your options for financial aid if you need it.

On This Page

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  How Much Does It Cost To Visit an Emergency Room Without Insurance?

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  How Does an Emergency Room Work?

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  Does Health Insurance Cover Emergency Room Visits?

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  How Do I Save at the ER?

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  How To Get Health Insurance That Will Cover an Emergency Room Visit

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  FAQs

How Much Does It Cost To Visit an Emergency Room Without Insurance?

The average cost of an emergency room visit without health insurance is around $2,600 but can be less or more depending on the facility and service, according to Mira. For example, a visit to the emergency room for a minor injury such as a sprained ankle or a cut that requires stitches can cost several hundred dollars.^[1] On the other hand, a visit for a heart attack or stroke can cost over $28,000.^[2]

Below is a table showing breakdowns of costs for common emergency room conditions and services:^[1]

In addition to the cost of the services provided, patients will be responsible for facility fees, physician fees and other charges. A facility fee covers the cost of using the emergency room, while a physician fee is linked to the medical care provided by the doctor or other medical professional.

What if I Can’t Afford To Pay My ER Bill?

If a patient cannot afford to pay the full cost of their emergency room visit, they may be able to negotiate a payment plan or apply for financial assistance. Hospitals are bound by law to offer financial assistance programs that provide discounted or free medical care to patients who meet certain income criteria.^[3] Any unpaid medical bills will be sent to collections. Your credit may be dinged and in severe cases, you may have to declare bankruptcy.

It is also important to note that there are laws in place to protect patients from excessive medical bills.

For example, hospitals are required to provide an estimate of the cost of services before providing them.^[4] This allows patients to save money by refusing services that they believe to be nonessential.

Keep in mind that emergency rooms are federally mandated under the Emergency Medical Treatment and Labor Act (EMTALA) to provide emergency medical services to anyone regardless of their insurance status.^[5]

How Does an Emergency Room Work?

When a patient arrives at the emergency room, the first step is usually triage, which is the process of prioritizing patients based on the severity of their condition. Patients with life-threatening conditions such as severe bleeding or suicidal feelings are given the highest priority.

According to Mira, emergency rooms will file patients into one of five acuity categories depending on their severity.^[1]

Those with emergency medical needs will be taken immediately to an exam room where they are evaluated by a physician or nurse practitioner. If the patient’s needs are non-urgent, they may be sent to the waiting room until another exam room opens up. This ensures there are spaces for new patients who require immediate care. If the patient's symptoms are dire, like suffering from head trauma, they’ll be taken to a specialized area like an operating room.

Based on the medical evaluation and tests completed, the medical staff will determine and explain the appropriate course of treatment. This may include medication, procedures such as stitching a wound or draining an abscess or surgery.

How Does ER Billing Work?

When a patient visits the emergency room, they can receive services from multiple providers, including the hospital, the physician and any specialists involved in their care. You can break down the various costs from each by triage fees, facility fees, professional fees and supplies. The triage fee can be anywhere between $200 to $1,000.^[1]

The second bill that the patient will receive is the facility fee in order to help cover the costs of running the physical building. The average facility fee in 2021 was $713.^[6]

The professional fee is next, with the average cost in 2021 being $321.[6] Note that each professional gives a quote for their services and may include radiologists, pathologists and more.^[7]

You will also be charged for any supplies used to treat you including syringes, laryngoscopes and laparoscopes, as well as durable medical equipment (DME) like braces or splints.

If you were transported via a ground ambulance service, you can expect to pay $1,277, on average, for that service.^[8]

Does Health Insurance Cover Emergency Room Visits?

Your health insurance policy covers ER visits as part of its standard benefits up to a certain amount. Also, insurance companies cannot charge you more for getting emergency services from an out-of-network provider or facility.^[9] You can see how much your out-pocket will be on your health insurance card. The average emergency room cost with insurance in 2020 was $1,150.^[10]

However, the amount of coverage may vary depending on the type of plan such as whether you have an HMO or PPO policy.

Your insurance company will have a negotiated rate with a healthcare provider or facility for how much your carrier will spend on a specific type of care.

Any costs that exceed this negotiated rate will usually need to be paid by you out of pocket.

How Do I Save at the ER?

ER visits can be expensive but there are several ways to save money and reduce the cost of an emergency room visit. Here are some tips to lessen the blow to your pocketbook:

• Know your insurance coverage: This includes your copays, coinsurance and deductibles. Once you have this information, you can make an informed decision as to when it’s best to spend your money.
• Consider an urgent care facility or telemedicine: While ERs are staffed 24/7, not all medical situations require a visit to the emergency room.^[11] In cases of minor illnesses or injuries, patients may be able to receive cheaper treatment at an urgent care clinic, their primary care physician's office or via virtual appointment
• Use community health clinics: These clinics can provide treatment for minor injuries and illnesses and can help avoid the higher cost of an ER visit.
• Negotiate your bill: Many hospitals have financial assistance programs that can provide discounted or free medical care to patients who meet certain income criteria.
• Regularly receive preventive care: Be sure to include regular check-ups, screenings and vaccinations that can help prevent serious health conditions and avoid costly ER visits.
• Be prepared: Bring your insurance card, a list of current medications and a description of your medical history. Doing so may cut down on any labs or tests they may otherwise run, saving you some money.

How To Get Health Insurance That Will Cover an Emergency Room Visit

If you want coverage for an ER visit but don’t have it, there are several ways to purchase health insurance:

• Individual or group health insurance plan: You can enroll in a plan through your employer, through the health insurance marketplace or directly from an insurance company. Most states hold open enrollment for health insurance from November 1 through January 15. Once you have a health insurance plan, you will be covered for emergency medical conditions, including those requiring an ER visit.
• Medicare: This is typically meant for the elderly. Medicare open enrollment begins October 15th and goes through December 7th every year with coverage beginning January 1st.
• Medicaid: This coverage provides health insurance for people who meet certain income requirements. Medicaid covers conditions requiring an ER visit.
• Children's Health Insurance Program (CHIP): Children in families who earn too much to qualify for Medicaid but cannot afford private health insurance may qualify for coverage. CHIP covers emergency medical conditions.
• Short-term health insurance: Coverage periods are typically less than 12 months.^[12] These plans can be more affordable than traditional health insurance plans, but they may have limited coverage for pre-existing conditions and may not cover all medical services, including some emergency medical conditions.
• Continuation of Health Coverage COBRA: This allows you to continue your employer-sponsored health insurance plan for a limited time if you recently lost your job. COBRA coverage can be expensive but it can provide coverage for emergency medical conditions, including those requiring an ER visit.