What an Emergency May Cost You

Emergency costs for a hospital visit can vary a lot.

It depends on whether you have an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization).

First off, what is an emergency or an emergency situation and how are emergency costs related?  A reasonable definition would be a medical condition that is bad enough to warrant a prudent person to believe that if they don’t get medical attention immediately, the condition could result in serious harm to themselves or the possible loss of use of a bodily function or organ (serious harm to life or limb).

In an emergency, you should always seek immediate medical attention, generally by going to the nearest hospital.  But what if the hospital you are taken to is not in your health plans Provider Directory?

Let’s say you are out of town and have an emergency situation and need to go to the hospital.

  • With your HMO you are covered under your plan’s benefit schedule as if you were using a Plan Provider.
  • With your PPO, however, coverage depends on two factors. Those are if the hospital is In-Network (a Plan Provider) or Out-of-Network (Not a Plan Provider).

PPOs usually have a two-tier Benefit Schedule, one for In-Network, one for Out-of-Network. Even in an emergency situation, you will pay according to the Out-of-Network schedule. This will cost you more. Generally, with a PPO, the Deductible and Out-of-Pocket Maximum will be twice as Out-of-Network than it is In-Network.

Therefore, if you have a PPO, it would be wise to know which local hospitals are In-Network. This is so when the EMT comes for you, you can tell them where to take you. It might also be wise when taking a trip to know which In-Network hospitals are closest to your route and destination.  It could save you money.