Obamacare: emergency care at out-of-network hospital

I am insured by Anthem Blue Cross and I went in to a Kaiser Permanente hospital for an emergency because it was close by.  Am I going to have to pay for the whole cost?

Brushed with Death

Dear Brushed with Death,

No, you will not have to pay the whole cost.  The Affordable Care Act requires plans to charge you the same co-pay or deductible for emergency care at “in-network” and “out-of-network” hospitals.  Plans also cannot make you do more paperwork or administrative hassle for emergency care at an out-of-network hospital.

The only thing that might trip you up is whether the plan considers it to be an emergency.  Most plans have wording that requires the emergency to be a situation where a prudent person would seek care.  Some plans make you pay more if you went in for a sore throat, for example.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.