In 2019, the study shows, patients enrolled in big companies’ health plans paid an average of $646 in copays and deductibles for each ED visit. A quarter of visits cost more than $907 out of pocket, and another quarter cost under $128.
About half of households can’t afford to pay the average deductible in an employer-sponsored insurance plan, the report notes. And more than a third of U.S. adults are unable to afford a $400 medical expense without borrowing.
While it’s not known how many people don’t go to an emergency department because of the anticipated cost, almost half of U.S. adults report that they’ve delayed care because of costs, according to a recent Kaiser survey.
One problem that people often face when deciding whether to visit an ED is that they don’t know how serious their condition is and what emergency care will cost, says Hope Schwartz, lead author of the report.
“When they go to the [ED], they don’t always know what their diagnosis will be and what their treatment costs will be. What we highlighted is that those costs could be very high or very low, and there’s no way to tell beforehand,” she says.
What costs so much?
Based on the paid claims data used in the study, health plans and patients paid a combined average of $2,453 for an ER visit. A quarter of visits cost $970 or less, and a quarter cost $3,043 or more.
Emergency department claims include professional fees and facility fees. The facility fees, which cover the cost of a hospital maintaining an ED 24/7, made up 80% of total costs, including a portion of doctors’ claims as well as laboratory and imaging fees.
But doctors’ claims for evaluation and management services were the largest part of costs, averaging $1,134 per visit. Procedures and treatments cost over $1,100 per visit, on average, while the average imaging claim cost $483, and the average cost for lab work was $230.
More than half of visits generated imaging claims, and about half of visits included lab claims.
The Kaiser Family Foundation report also looked at the costs of several common ED diagnoses. The most expensive diagnosis was appendicitis, which cost nearly twice as much as heart attacks, partly because it often led to surgery in the emergency department. On average, a visit for appendicitis cost $9,535, of which $1,717 was an out-of-pocket expense.
In addition, the researchers examined lower-cost diagnoses that generally do not require imaging or extensive treatment in the ED. These included upper respiratory tract infections ($1,535 total, $523 out of pocket), skin and soft tissue infections ($2,005 total, $572 out of pocket), and urinary tract infections ($2,726 total, $683 out of pocket).
While these diagnoses can sometimes require admission to the hospital, in otherwise healthy adults they are typically evaluated with basic lab tests, and patients are discharged with prescriptions, according to the report.