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3 essential things you need to know about emergency room visits

Have you been to an emergency room (ER) lately?  If not, you may be surprised to learn that ER trips are quite common. 

In 2011, 1 in 5 Americans reported at least one trip to the emergency room (ER), according to the Centers for Disease Control and Prevention.

Common reasons for ER visits include chest pain, abdominal pain, headaches, fever, shortness of breath and traumatic injuries such as head wounds.

Emergency medicine deals with the evaluation and initial treatment of medical conditions caused by trauma or sudden illness. ER doctors are trained to quickly treat life-threatening illnesses.

How much can an emergency room visit cost?

The good news is that ER trips are now covered as one of the 10 essential health benefits in the Affordable Care Act (also known as Obamacare).

The total cost for an ER visit will depend on your health insurance plan and the reason for your visit.

emergency room visit For example, minimum coverage in the Affordable Care Act’s insurance marketplace, also known as a ‘bronze plan,’ pays for 60 percent of the cost of an ER visit, with a co-pay of 40 percent. 

ER coverage under private insurance plans varies greatly so it’s best to know the individual details of your plan.

1. When should you go to ER -- and when to go to urgent care

Sometimes, it’s difficult to know if a problem is truly an emergency, says Valerie Roth, a practicing emergency medicine physician with Emergency Physicians Medical Group, PC in Ann Arbor, Michigan.

So what conditions qualify as an emergency? "Any medical problem that could be life-threatening if left untreated should be seen in the ER immediately," Roth says.

Examples of life-threatening situations include:

  • Strokes.
  • Heart attacks.
  • Loss of consciousness.
  • Allergic reactions with facial swelling.
  • Trouble breathing.
  • Fever in a newborn baby.

In contrast, urgent care centers are for minor issues including fever in an otherwise healthy person, earaches, sprains, rashes, animal or insect bites, and minor cuts. According to the Urgent Care Association of America, urgent care centers reported an average of 14,000 patient visits per center in 2013.

If you have a question about whether to seek immediate help on a minor problem or to wait for an office appointment, call your primary care doctor for advice. Some health systems have after-hours hotlines you can call for advice about medical concerns. 

If you require immediate treatment for a medical emergency, it's best to call an ambulance instead of trying to drive yourself or a loved one to the hospital.

2. What to expect in an ER

  • Check-in. You'll be asked for basic information such as your name, insurance information, birth date, an emergency contact person and the reason for your visit.
  • Triage. Triage is the process for sorting people into groups based on their need for immediate medical attention. A medical provider will assess your condition by checking your vital signs such as heart rate, temperature and blood pressure. Depending on your problem, lab tests or imaging tests such as X-rays may be ordered.
  • Waiting room or exam room. Depending on how busy the ER is and how severe your condition is, you’ll either be placed in the lobby or directly into an exam room. ERs are busy places, so you may have to wait a while to be seen. From 2003 to 2009, the average wait time in U.S. emergency departments increased from 46.5 minutes to 58.1 minutes.

You should never lie about your condition in order to be 'moved up the line,' but if your pain worsens or you develop a new symptom, you should alert the triage nurse or the person at the front desk.

  • Medical exam. During the medical exam, the health care provider will you’re your medical history, examine your body, and ask you to describe your symptoms.

Different types of health care providers may conduct the medical exam including doctors, nurse practitioners, and physician’s assistants.

"The majority of physicians who work in the ER are trained specifically in emergency medicine," says Dr. Travis Ulmer, vice president of emergency medicine physicians at Doctors Hospital in Columbus, Ohio.

Specialists may also be consulted for complex cases. For example, if a patient has a broken hip, an orthopedic surgeon may be brought in.

  • Treatment plan. After your test results are returned, the doctor will discuss the findings with you and determine the plan of action. From this point, the provider will either recommend admission to the hospital or discharge you with instructions to follow up with your primary care physician or a specialist.

3. How to maximize care while in the ER

  • Be completely honest. For example, it’s important to let the doctor know if you’ve mixed prescription drugs with alcohol. This important detail may change the treatment plan and medications they recommend for you.
  • Before you ever need to go to an ER, make a list of your physicians' names and contact information, illnesses, surgeries, and medications with dosage requirements in a file at home or on your smartphone. These lists can speed things up during an ER visit.
  • Ask questions to ensure you understand what's happening. A family member or friend can also ask questions on your behalf and take notes for you.

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