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Comment by aquaphile | Hacker News Reader

Emergencies are always considered In-Network by law *.

For example, if you are traveling Out of Area (OOA) and skiing in Colorado, and you have a medical emergency, emergency room care is considered In-Network. Any financial responsibility you have under your health plan (coinsurance, copay) should be calculated as part of In-Network.

* If you have an HMO or EPO plan, it is black and white language. If you have a PPO plan, legally it is a bit squishy because of the already provided for out of network (OON) access. BUT - generally - any emergency is considered in network no matter what product you have and where you are.

Source: I work in health insurance at Evry Health (https://evryhealth.com)

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He went to a clinic, while you, me and he may all agree it fits the definition of an emergency, he didn't go to the ER.

Getting emergency care: In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can't charge you more for getting emergency room services at an out-of-network hospital.

https://www.healthcare.gov/using-marketplace-coverage/gettin...

For something fairly simple like a cast, that can still end up more expensive than the clinic option though, depending on your insurance. ER co-pays and co-insurance can be pretty high. For example, a typical ACA/Obamacare "Silver" level plan in my area has 20-40% co-insurance on an ER visit (until the $5k-10k annual out-of-pocket max), which can easily be more than whatever you'd end up paying for the non-ER option to set a broken arm.

> Emergencies are always considered In-Network by law *

Not quite. Balance billing for care received in the emergency department is illegal if the ER accepts Medicare payments.

In other words

- care received outside the emergency department (once admitted as a patient) can be balance billed

- care received in an urgent care clinic can be balance billed

- standalone ERs (which are increasingly common, as they're more profitable for the owners) can balance bill patients

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