The Cost of Insurance – How ER Visits Affect Your Premium

emergency roomBlue Cross Blue Shield of North Carolina has been providing quality, affordable health insurance to the residents of NC since 1933, but many members are concerned about recent or future rate increases.  In fact, it’s all over national news – the cost of health insurance is on the rise.  But do you know why?  Truthfully, it’s a complicated answer.  One of the reasons insurance premiums are going up, however, is because of the growing number of Emergency Room visits occurring on a regular basis.  Despite the fact that most people know the ER is rarely the most efficient place to get health care, many Americans still utilize the ER in non-emergency situations.  And the Emergency Room is expensive!

In fact, based on the top 10 most common reasons people visit the ER, the average cost of service is $1200 a visit, which is nearly one and a half times the average monthly rent in the United States.  As expensive as it is, however, only 11% of ER visits actually result in hospital admission meaning the  vast majority of people using the ER are using it in non-emergency situations.  A recent study concluded that 65% of health problems driving people to the ER are actually considered non emergencies by health care professionals.  Headache, nausea, vomiting, dizziness, urinary tract infection and painful respiration are just some of the top reasons people go to the Emergency Room and oftentimes, these conditions could be treated by a primary care physician within twelve hours at a fraction of the cost.  In fact, studies indicate that treating these non-emergency conditions at either an urgent care facility or retail clinic could save over $4.4 billion.

But the problem is getting worse.  Since 2014, Emergency Room visits have increased a staggering 27% among customers who receive insurance plans through the Affordable Care Act Marketplace.  This is one of the many reasons health insurance premiums are on the rise.  That statistical increase not only creates Emergency Rooms that are overcrowded and ER bills you can’t afford, it also puts a strain on the health industry as a whole, including health insurance companies like Blue Cross Blue Shield NC.

In an effort to help members, BCBSNC offers a 24/7 nurse line you can call when you just aren’t sure whether or not your symptoms constitute a visit to the Emergency Room.  Sometimes, it can be difficult to know exactly what makes an emergency, especially in small children and the elderly, and having a professional opinion can give you peace of mind.  The nurse line can help you determine what course of action best suits your circumstance and could save you from an exhausting and expensive trip to the ER.  Also, keep in mind that many urgent care centers and clinics are open long after regular business hours.  Check the facilities in your area to see what hours they operate and to determine if such a clinic might be an alternative to the Emergency Room.

Blue Cross Blue Shield of North Carolina will continue to provide quality health coverage to the residents of North Carolina, despite rising costs for both the company and the consumer.  As a BCBSNC member, you can do your part by limiting ER visits to emergency situations only and by utilizing your primary care doctor or urgent care facilities for lesser health issues.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.


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