Keeping Tennessee Healthy
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Will You Have Health Coverage For An ER Visit?

Are you aware that one in six ER claims was denied by a number of big California HMOs? Oftentimes, ER claims are denied. Why?

One of the big issues when denying claims is your plan’s provider network. If you have an HMO, you wouldn’t get any coverage if you seek medical attention from healthcare providers that are out-of-network. Since it is a medical emergency, you are usually taken to the nearest hospital. You don’t have time to argue with the medics if they take you to an out-of-pocket network hospital.

To address this concern, one of the mandates of the health care reform law required insurance companies to cover emergency medical care, whether from in-network or out-of-network, at the same rate. Health plans are also prohibited to require prior authorization for emergency health care. As long as you feel that the symptoms are life-threatening such as chest pain, even though you are diagnosed with indigestion, your claim must be covered by your insurer.

The health care reform law also required insurance companies to cover preventive care services with no out-of-pocket costs. This applies to all insurance plans, even to catastrophic coverage, post health care reform. You will need an updated plan to get preventive care covered at 100 percent.

If you want to check to see how much ER treatments cost, search for “emergency department” at You can customize the results by entering your zip code. For example, level 1 without a zip code would cost around $431 (physician and hospital fee), without staying overnight in the hospital. Life threatening conditions would cost around $3,495 (no overnight stay).

What’s scary nowadays is that hospitals charge uninsured patients more than two-and-a-half times what they charge insurance companies for the same thing. If you still do not have Tennessee health insurance, now would be the best time to get a plan. The cost of getting health care coverage is just a drop in the bucket compared to the out-of-pocket costs that you need to pay if you stay uninsured.

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Memphis, TN 38111
Phone: (877) 224-2052

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