I need to know what to say in the Emergency Room.
June 2, 2012 6:47 PM   Subscribe

Which address should I give when I go to the Emergency Room? This is turning out to be a surprisingly stressful and complicated question.

My doctor has instructed me to go to the ER tomorrow morning if a medical issue that's flared up in the last week doesn't get better by then. (Happy to give the details on the underlying issue if it's of importance.)

I live in Brooklyn, and will be going to a hospital in Brooklyn - but my insurance is from New Jersey, and the address I have on file with the insurance company is a New Jersey address. Whenever I go to a doctor (usually in NJ), I give them the New Jersey address, so the insurance company doesn't make it an issue. (The New Jersey address is my parents' home - for a number of reasons, it's much easier for me to get insurance this way than it is to get the necessary insurance in Brooklyn.)

When I fill out papers at the hospital, which address should I put down: my actual residence, in Brooklyn, or my New Jersey address, which I use to be eligible for insurance through this company? Will it impact the care I receive at the hospital? Or what is or isn't covered by insurance?

Thanks in advance for your help on this - my insurance has consistently been an incredibly stressful component of navigating my health in the last few years, and this is no exception.
posted by Ash3000 to Health & Fitness (11 answers total)
The new jersey address.
posted by fluffy battle kitten at 6:57 PM on June 2, 2012 [1 favorite]

I can't think of a down side to sticking with your NJ address.
posted by Rock Steady at 6:59 PM on June 2, 2012

New Jersey. You're having an emergency, and as far as your insurance knows, you're just out of town.
posted by puddinghead at 7:01 PM on June 2, 2012

In terms of billing, I'm thinking you should give the NJ address. I can't think of an official reason why having the Brooklyn address on the claim the hospital submits to the insurance company should be a problem (unless you're breaking the rules being on the NJ insurance and the Brooklyn address would tip them of?), but, as you have probably learned, whatever can get messed up when it comes to healthcare billing probably will and fixing it will be a huge headache. Have you checked that your NJ plan is in-network at the Brooklyn hospital?
posted by ThePinkSuperhero at 7:03 PM on June 2, 2012 [1 favorite]

Use the New Jersey address and if you later find it necessary to use the Brooklyn address (for example if you need to get info from hospital staff at on pharmacies or specialists near you, etc.) just share it with them and say "My home is in New Jersey with my parents but at the moment I am staying at (current address)." Students often continue to use their parents' address as their home base; I'm sure you wouldn't be the first person ever to need to give the hospital two addresses, and they probably won't think much of it.
posted by BlueJae at 7:08 PM on June 2, 2012 [2 favorites]

Response by poster: Thanks everyone for the prompt, immense help - just reading everyone's responses here has been of real assistance.

ThePinkSuperhero - Unfortunately, I don't believe that my plan is covered in-network at this hospital, or at least I don't see it listed here. Unfortunately, I think it's unlikely (based on my past experience with this insurance) it'll be listed at any area hospitals - but a. I'm not sure how to easily find a hospital where it's in-network, especially as I've looked through my insurance site for NY doctors and found later they were only covered at an obscure NJ office they had, and b. I'm not sure it makes sense to drive to NJ just to go to an emergency room.

(Part of my anxiety on this is that I find it *very* difficult to understand how my insurance works, partially because I've gotten such conflicting answers at different times from my insurer.)
posted by Ash3000 at 7:16 PM on June 2, 2012

Ash300 for an actual emergency you should be able to go to the closest hospital on most plans. It is when they admit you that issues really pop up. Which doesn't mean you won't have to be vigilant re billing afterwards. I am confused that there are no hospitals in your vicinity in your network. Have you tried calling the hospital you plan to use and ask if they take your insurance? They can check.
posted by emjaybee at 7:39 PM on June 2, 2012

I don't think your Brooklyn address is a problem unless your plan is limited to residents of New Jersey. If it has that limitation, it probably won't influence the care you receive in a Brooklyn ER, but could really effect your cost.

Using an out-of-network ER could create a big financial burden for you. It's common for some types of plan to limit out-of-network benefits to situations that may be an immediate threat to your life or health. That's different than having the doctor tell you to go to the ER at a future date if a situation isn't resolved. A non-covered ER visit can cost thousands of dollars; an admission will certainly cost thousands. Unless you're completely certain that you'll only be getting (for example) a single lab test (which would still costs you hundreds if out of network), I think it would be worth going to an in-network hospital to have the cost covered.

I'd also recommend checking your health plan's online provider directory as a more authoritative network reference than the hospital's listing of plans.
(Ain't our health system great? USA! USA!)

Best wishes for your best health!
posted by Snerd at 8:05 PM on June 2, 2012

I agree with those above who say you should make every possible effort to go to an in-network hospital, particularly if there is a chance you could be admitted and/or seen by multiple providers.
posted by ThePinkSuperhero at 8:28 PM on June 2, 2012 [1 favorite]

3 big drivers here that could be of major significance regarding what comments I would make.

1) is this insurance an individual plan, a state sponsored plan like medicaid or a group plan through an employer?

2) do you list your parents address because you are listed as a dependent under their plan?

3) what type of plan do you have? Specifically, does it have out of network benefits?

For a true emergency, go to the ER, though you might save for some types of situations by going to an urgent care clinic rather than an ER. Where it is appropriate, it can save quite a bit on costs that way, and sometimes on your copayments.
posted by slavlin at 8:59 PM on June 2, 2012

I'm a doctor and although I admit I am not familiar with the intricacies of insurance and billing (thank goodness), I am not aware of any way in which your address would impact your insurance coverage. Typically, to my understanding of it, insurance companies specify in-network hospitals that are set in stone, and it doesn't matter where you live, what matters is just if the hospital is on their list.

The ER will just use the address to send you the bills.

The beauty of the ER is that the treatment you get is almost never impacted by whether you have insurance coverage or what that coverage is (unless you tell me you're paying out of pocket and you want me to try my best to keep things as cheap as possible for you).
posted by treehorn+bunny at 9:00 PM on June 2, 2012

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