Going to the emergency room for medical care that could be handled elsewhere is costing the U.S. health care system an extra $32 billion a year, according to a new study by the nation’s largest insurer.
In fact, the research, released this week by UnitedHealth Group, parent company of insurer UnitedHealthcare, found that as many as two-thirds of the nation’s 27 million annual emergency rooms could be avoided. The data comes from an analysis of 2018 claims from employer-sponsored health plans.
At the heart of the findings are some staggering price differences. For instance, a trip to the emergency room is on average 12 times higher than being treated at a physician’s office for common ailments. That translates to $2,032 on average compared to $167.
That same trip is also 10 times higher than a visit to urgent care, which on average costs $193. This can be a crucial difference in Texas, where patients continue to be confused between urgent care clinics and the states’ hundreds of free-standing emergency rooms, health analysts say.
Another factor in emergency room care versus other venues is the added facility fees, or price charged for the overhead costs of equipment and staffing. Those facility fees on average tack on $1,069 per visit, the research found.
The claims data showed ailments frequently treated in the emergency room include cough, bronchitis, headache, sore throat, nausea and upper respiratory infection.
Still, doctors, hospitals, and some consumer groups have complained that emergency room price comparisons, especially those conducted by insurance companies who have a stake in the result, are overly simplistic if not outright dangerous.
Often symptoms can mean a minor condition– or signal a life-threatening issue. While some patients do overuse emergency rooms, others may sincerely not know how serious a condition is, some health experts caution.
Last year, Blue Cross and Blue Shield of Texas caught national attention when the state’s largest insurer instituted a measure to scrutinize its out-of-network health maintenance organization plan (HMO) emergency room claims and deny payment if a later review found patients should have gone elsewhere.