Emergency Room visits are always In-Network, but beware what happens next

When a medical emergency strikes, the last thing you should be worried about is whether the hospital is in your insurance network. And thankfully, you don’t have to — at least at first.

Federal laws like the Affordable Care Act, the No Surprises Act, and EMTALA ensure that care for emergent, life-threatening conditions is always billed as in-network, even if the hospital or doctors you see don’t normally accept your insurance.

That’s the good news.

But there’s a second part to the story — and it’s where many patients unknowingly end up with out-of-network bills. Let’s break it down.

What counts as an emergency?

An “emergency medical condition” is defined as anything that a reasonable person would believe needs immediate attention to avoid serious harm. That includes:

• Chest pain or signs of a heart attack

• Difficulty breathing

• Sudden loss of consciousness

• Severe bleeding

• Stroke symptoms

• Serious injuries or trauma

In these situations, you should always go to the nearest emergency room. The law protects you during this critical window.

The catch: Post-stabilization care

Here’s where things get tricky.

Once your condition is stabilized — meaning you’re no longer in immediate danger — the hospital may transition you to post-stabilization care. This could include:

• Staying overnight or being admitted for observation

• Getting additional scans or procedures

• Seeing a specialist

• Being transferred to another facility

At this stage, the law no longer requires that care be treated as in-network. And unless you’re careful, you could be on the hook for out-of-network charges without realizing it.

When and how can hospitals ask you to pay for out-of-network care?

Hospitals may ask you to sign paperwork that includes notices and consents related to receiving out-of-network post-stabilization care, and there are some conditions about when they can do so:

• You must be in a condition to give informed consent
• The notice and consent form must be given separately from other documents, not bundled or buried with other paperwork
• The form must be given to you how you prefer, whether printed or emailed
• The form must be made available in any of the 15 most common languages in the state where you got care
• The form must be given in advance of receiving care, though timing requirements vary depending on when care is scheduled

What should you ask before you sign?

Before signing a notice or consent form:

• Ask: “Is this facility in my insurance network?”

• Confirm whether any specialists you’ll see (like a surgeon, anesthesiologist, or radiologist) are also in-network.

• If they’re not, ask if you can transfer to an in-network hospital or provider.

• Don’t sign consent forms agreeing to out-of-network charges unless you fully understand what they mean.

This doesn’t mean you should delay necessary care, but it does mean that once you’re stable, it’s smart to pause and check.

What you can do now to avoid surprise bills

1. Know your preferred hospitals. Check now which emergency rooms and facilities are in-network with your plan.

2. Call your insurance agent. We can help you verify network status or find a plan that includes the hospitals you trust.

3. Stay informed. Knowing how post-emergency care works helps you avoid unnecessary expenses later.

Questions about your coverage?

If you’re unsure whether your plan includes the hospitals or specialists you want, or if you’d like help reviewing your current coverage, we're here to help.

Contact us today to go over your options or find a plan that fits your needs.

Disclaimer: This blog post is for informational purposes only and does not constitute legal, financial, or medical advice. For specific guidance on coverage or billing, consult your insurance provider or a licensed professional.