Emergency Room Services
Medical emergencies don't wait, and neither should your coverage. Our plans provide comprehensive emergency room benefits so you can get the urgent care you need without worrying about crushing medical bills.
Medical emergencies don't wait, and neither should your coverage. Our plans provide comprehensive emergency room benefits so you can get the urgent care you need without worrying about crushing medical bills.
Emergency room visits are among the most expensive healthcare services in America, with average costs ranging from $1,200 to $3,000 or more depending on the treatment required. For serious emergencies involving trauma, cardiac events, or stroke, costs can quickly escalate to tens of thousands of dollars.
Emergency room coverage ensures that when a medical crisis strikes—whether it's a car accident, a sudden illness, a severe injury, or symptoms of a heart attack or stroke—you can seek immediate care without hesitation. The last thing you should worry about during a medical emergency is whether you can afford treatment.
Our emergency room coverage provides protection for the unexpected moments in life when you need medical care immediately. With proper coverage, you can focus on getting well while we help manage the financial burden.
Ground and air ambulance transportation to the nearest appropriate medical facility, including paramedic care during transport.
Coverage for emergency room facility charges, equipment usage, treatment rooms, and all associated facility costs.
Emergency physicians, specialists, on-call surgeons, and consulting doctor fees for your emergency care.
Immediate treatment for serious injuries, accidents, burns, and life-threatening conditions requiring emergency intervention.
All medications, IV fluids, pain management, and pharmaceutical treatments administered during your ER visit.
X-rays, CT scans, MRIs, ultrasounds, blood work, EKGs, and other urgent diagnostic tests needed for your care.
Understanding when to go to the emergency room versus urgent care or your doctor's office can save you money and ensure you get appropriate care. Seek emergency room care for:
Chest pain, difficulty breathing, signs of stroke (facial drooping, arm weakness, speech difficulty), severe allergic reactions, loss of consciousness, or heavy uncontrolled bleeding.
Major trauma from accidents, deep wounds requiring stitches, broken bones with visible deformity, head injuries with confusion, spinal injuries, or severe burns.
Sudden severe headache, high fever with stiff neck, sudden vision changes, coughing or vomiting blood, severe abdominal pain, or signs of poisoning or overdose.
Suicidal thoughts or actions, severe psychiatric episodes, or any situation where someone poses an immediate danger to themselves or others.
Knowing the difference can save you significant money while still getting appropriate care:
Under federal law (the No Surprises Act) and most insurance policies, emergency services are covered at in-network rates even at out-of-network facilities. You cannot be balance billed for emergency care beyond your normal cost-sharing amounts.
No. Emergency care never requires pre-authorization. However, if you're admitted to the hospital after your ER visit, your insurance company should be notified within 24-48 hours to ensure continued coverage.
Costs vary by plan, but typically include an ER copay ($150-$500) plus any deductible and coinsurance that applies. If you're admitted, the ER copay is often waived and hospital inpatient benefits apply instead.
Yes, emergency ambulance transportation is covered when medically necessary. This includes both ground ambulances and air ambulances (helicopter or fixed-wing) when ground transport isn't feasible.
Some plans charge higher cost-sharing if your ER visit is deemed non-emergent. However, if you reasonably believed you were having an emergency based on your symptoms, coverage typically applies at emergency rates.
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