Avoid unexpected ER bills with one question

Posted: Updated:

PHOENIX -- Remember Katie Libby? She was upset after receiving a nearly $500 emergency room bill.

The bill wasn't from the ER because that was covered by her insurance. Instead, the bill was from the physician's assistant who treated her in the emergency room.


"You just assume since the hospital takes your insurance so do the doctors," Libby said. "I mean, who would think differently?"

3 On Your Side discovered what happened to Libby is actually very common.

Just because a hospital accepts your medical insurance, it does not mean the ER doctor will.

Contact the Greater Phoenix Association of Health Underwriters at 480-292-7746 or visit .

Well, after our report aired, 3 On Your Side got a call from Regina Esposito. She is with an organization called Greater Phoenix Association of Health Underwriters.

"For the most part, that physician that sees you in the ER is an independent contractor to the hospital you are in," Esposito said.

The association is made up of insurance professionals who assist people like Libby.

"Suppose there's a health insurance claim that you just can't figure out and you have no one to go to, we have professionals that will help you," Esposito said.

She said there are steps consumers can take to protect themselves from unexpected bills.

First and foremost, you have to determine if going to the ER is absolutely necessary. Is it really an emergency?

"We talk about life or limb threatening," Esposito said.

If you answer yes, then the ER doctor will still take your insurance even if that doctor is not contracted with them.

The insurance industry calls it "accepting assignment."

To make sure your situation is truly an emergency, Esposito recommends calling your doctor or nurse help line for authorization if you can.

"If the doctor says you should go to the emergency room, if the nurse practitioner you speak to from your insurance company says to go, you belong in the emergency room, that's as good as gold," Esposito said.

OK, let's say you're in the emergency room. Now, Esposito says you have to know the right questions to ask.

"You never ask, 'Do you take?' You never ask, 'Are you covered?' You ask, 'Are you contracted with my insurance?" Esposito said. "The word contracted is key."

If you do receive a bill from the ER doctor, Esposito says make sure the doctor has your correct insurance information and then ask them to bill your insurance company even if they are not contracted with them.

If your visit was truly an emergency, then the treating doctor should accept whatever your insurance company pays.

Again, this is called "accepting assignment."

"When it is a true emergency, life or limb threatening, those doctors do accept payment," Esposito said.

Esposito says it all starts at the very beginning. You have to decide if your situation is an emergency.

If it is, your insurance and your ER doctor will agree on a payment, and you should be left in the clear.

"The responsibility is up to the insured," Esposito said. "It's up to the member, to the individual, to make that educated decision, 'Do I really belong in the emergency room?"