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What Is Emergency Room Insurance?

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  • Written By: Lainie Petersen
  • Edited By: Melissa Wiley
  • Last Modified Date: 19 November 2016
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Emergency room insurance covers the costs of an emergency room visit. In many health insurance plans, emergency room care is part of a policy's standard coverage. As some insurance companies treat emergency room costs differently than other medical expenses, however, some people choose to take out a supplementary emergency room insurance policy. Other types of health care plans, including those that provide only limited coverage, may also include an emergency room benefit. Individuals who have health insurance should clarify with their insurer the restrictions on emergency room coverage as well as the procedure for notifying the insurance company so as to avoid having to pay out of pocket for costs that might otherwise be covered under emergency room insurance.

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Visiting an emergency room can be expensive, so many insurance companies attempt to discourage people from visiting an emergency room for non-emergencies by restricting the amount of money paid in claims for emergency room care when it is not clear that an actual medical emergency existed. In some places, laws limit the degree to which insurance companies can engage in this practice, often requiring them to offer a comparable level of coverage for emergency room use as they provide for standard medical care, provided that the patient can show that the trip to the emergency room was a reasonable action to take. Some insurance companies, however, do request that policy holders contact them within a certain time frame after seeking emergency room care in order to receive maximum coverage. For this reason, policy holders should take action before an emergency occurs to find out what they need to do if they or a family member are admitted to an emergency room.

Some health insurance policies may offer minimal coverage for both emergency and non-emergency medical care, providing any significant coverage only for major medical problems that are very expensive to treat. In these major-medical or high-deductible plans, policy holders are expected to pay out of pocket for much of their medical care until a certain threshold is reached during the year. A supplemental emergency room insurance policy can provide additional coverage, often in the form of cash payments or reimbursements, for emergency room care that is not covered under the patient's health insurance policy. Other types of emergency room insurance include limited coverage policies that provide predetermined cash payments to individuals who may not be able to get standard insurance but who need some assistance in paying medical bills.

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