What happens at the ER when you have no insurance

Can I go to the ER if I have no insurance?

Yes, you can go to the ER. If you think you are having an emergency, go right away. Call 911 if someone has chest pain, trouble breathing, signs of a stroke, heavy bleeding or a serious injury. Call 911 for any problem that seems life-threatening too. Do not wait because you are worried about money, since fear of a bill should never keep you from emergency care.

This page explains your rights and your options for the bill. It is general information and not medical advice.

What the law says

A federal law called EMTALA, which is short for the Emergency Medical Treatment and Labor Act, protects you. The Centers for Medicare and Medicaid Services (CMS) is the federal agency that oversees it. CMS explains that a hospital with an emergency room must give you a medical screening exam when you ask for care for an emergency condition. If the exam shows an emergency, the hospital must treat you until you are stable. These duties apply regardless of your ability to pay.

In plain words, the hospital has to look at you and treat the emergency first. It cannot send you away because you have no insurance. Active labor counts as an emergency under this law too. If the hospital cannot give you the care you need, it must arrange a safe transfer to a place that can.

This law protects your right to get care, but it does not make the care free. You can still get a bill afterward.

What happens with the bill

After an ER visit you may get more than one bill. The hospital may bill you for the use of the emergency room. The doctor who saw you may bill separately. So may other groups, such as the people who read your X-ray or run your lab tests. This is normal, but it can feel confusing.

Here are some steps that often help.

1. Do not ignore the bills, and open every one and keep them in a folder.
2. Ask for an itemized bill, which is a list of every charge, line by line. Look for mistakes or charges for things you did not get.
3. Ask each office about a discount for people who pay on their own, and ask about payment plans.
4. Ask about financial assistance, which the next section explains.

If a bill is more than you can handle, we have two guides that can help. One is on help paying medical bills and the other is on negotiating a medical bill.

What to do at the ER if you have no insurance

First, get the care you need. Tell the staff what is wrong, and give them your correct name and address, because the hospital uses these to send the bill. If you are asked about insurance, you can say you do not have any.

Before you leave, there are a few helpful things to do. Ask for your discharge papers, which explain what was done and what to do next. Ask if the hospital has a financial assistance office, and get the name of someone to call about the bill. Write down the date, the hospital's name and the names of the doctors you saw. These details will make it easier to check the bills when they come.

How hospital financial assistance works

Many hospitals will lower or erase a bill if your income is low. The CMS website says that nonprofit hospitals must give financial assistance to eligible patients who cannot afford to pay. This is sometimes called charity care. The IRS requires nonprofit hospitals to have a written financial assistance policy. It explains who qualifies, how much help they give, and how to apply. The policy also has to say that people who qualify cannot be charged more than the amounts generally billed to people who have insurance. That means no more than what the hospital usually gets paid for the same care by insurance.

You usually have to ask, because most hospitals do not give the discount automatically. Search the hospital's name with the words "financial assistance," or call the billing office and ask for the policy and the application. Our guide on how to apply for hospital financial assistance covers the documents you will need. It also explains what to do if you are turned down.

Be careful with the timing. The IRS says a nonprofit hospital generally has to wait at least 120 days after the first bill before it takes major collection steps. Those steps include reporting you to a credit bureau or suing you. Do not rely on that wait alone, and apply as soon as you can.

Will I get a good faith estimate for emergency care?

No, you will not get an estimate during an emergency. A good faith estimate is a written price quote that uninsured patients can get before planned care. CMS says emergency care does not come with one, which makes sense because nobody can plan an emergency. You can read more about estimates for planned care in our guide on the good faith estimate.

When urgent care or a regular doctor is a better choice

Not every problem is an emergency. A mild fever, a sore throat, a small cut, a sprained ankle or a urinary infection may be better handled somewhere else. An urgent care center, a community health center or your own doctor can treat them. These places often cost much less than an ER, and the wait is often shorter. Our guide to urgent care costs without insurance explains what to expect.

If you are not sure how serious something is, you can call a nurse line or a doctor's office and ask. If it might be life-threatening, choose 911 or the ER. Having a regular doctor before you get sick also helps, because many small problems can be handled before they grow. Our directory of cash-pay doctors is a place to start.