Ask a Doctor: When to Access the Emergency Room

January 28, 2016
ER2 Dear Doc:

I am pregnant, early in my first trimester and I had some vaginal bleeding. I immediately went to the emergency room because I knew that something could be wrong with the pregnancy. I was examined and an ultrasound was done. Thankfully, everything turned out to be okay, but a little while later, I received a large bill. I have a high-deductible insurance plan so apparently I now have to pay for this visit to the emergency room and the tests that were done. This is a huge financial burden to my family. Was I right to go the emergency room when I saw bleeding? What are the alternatives?

Dear Reader:

This is an excellent question and I am so happy to hear that your baby is doing well. The health care world has changed significantly in recent years and it can be difficult to keep up. More people are choosing high-deductible insurance plans as a way to keep down their health care costs. In a high-deductible plan, the monthly fee for health insurance is typically low making the plan more affordable. However, when a person uses health care services they are responsible for all fees until the deductible has been met. Deductibles may range from as little as $1,300 for a single person to $13,000 for a family. Preventative health care, as mandated by the Affordable Care Act, is covered 100 percent and not subject to the deductible but any trip to the emergency room would be subject to the deductible.

Making the decision to go to the emergency room or to urgent care can be difficult. In the event that a person is experiencing symptoms of a life-threatening illness; for example chest pain, loss of consciousness, stroke symptoms such as slurred speech or loss of bodily functions, signs of serious infection, severe pain, bleeding or a traumatic injury; it is reasonable and potentially lifesaving to seek immediate care in the closest emergency room. That being said, many people are tempted to go to the emergency room for less serious conditions because they either do not have a primary care physician (PCP) or they are unable to get an appointment with their PCP. Unfortunately, a visit to the emergency room will be much more expensive than a visit to your doctor’s office and the patient may ultimately end up with the bill. In response to the changing health care world many PCP offices in our region are working hard to increase the number of appointments available each day for acutely sick patients. Many offices are also extending their hours beyond traditional business hours to include early morning, evening or even weekend appointments. There are many urgent OB/GYN conditions that can be managed by OB providers in the office setting. You were absolutely correct to be concerned about the health of your baby when you saw bleeding. In an event like this I would recommend calling your OB provider first. Typically, your call would be addressed quickly by a nurse. The nurse would then be able to speak with the OB provider and make a plan of care that could include a same day office visit and possibly an ultrasound or other lab work. Depending on your insurance you may still have a bill related to the high deductible plan but the additional emergency room fees may have been avoided.

It is important to remember that ultimately you know your body best. If you are suffering from an illness that you feel needs immediate emergency attention, besides the conditions previously mentioned, then using the emergency room or urgent care is always an option. However, in this age of rising health care costs with the patient bearing more of that cost, it makes good financial sense to utilize your OB office whenever possible.

gellasch_taraTara Gellasch, MD, is the Associate Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice. Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider. To send questions on women’s health, please email Dr. Tara Gellasch’ s assistant, Monica Decory at and write “Ask a Doc” in the subject line. The Women’s Center at NWCH is located at 1250 Driving Park Avenue, Newark. Call 315.332.2427 to schedule an appointment.