Going To The Emergency Room Is Like Getting Two Kicks To The Groin

Our first visit to the emergency room unfolded three years ago when our daughter displayed signs of anaphylaxis due to a food allergy. Unsure of what steps to take, we dialed 911, which led to an ambulance arriving promptly to transport us 16 minutes to the nearest hospital.

The paramedics administered epinephrine, then the ER doctors swiftly took over, and four hours later our daughter was deemed safe and sound. Because of COVID policies at the time, only one parent could accompany her, so I followed the ambulance and was anxiously stuck in my car for the entire four hour wait. In preparation for potential future allergy attacks, we acquired children's Benadryl and an epipen.

Despite our gratitude for the ambulance and medical care, the shock of a $3,532 ambulance bill followed. We had assumed our insurance plan would cover most of the cost, and were dumfounded when they did not. This led to my wife spending hours and hours engaged in heated discussions with both AMR (ambulance provider) and United Healthcare (insurance carrier), attempting to secure in-network coverage. After all, why were we paying $2,100/month in health insurance premiums?

Regrettably, on February 8, 2024, we found ourselves in need of another visit to the emergency room.

My goal for this post is to help you prepare for the unexpected and research your existing healthcare plan. The last thing you want happen is to be blindsided by a large bill you thought insurance would cover.

The Incident

After a Lunar New Year performance lasting from 9:15 am to 11:30 am at my son's school, our kids had the rest of the day off. We spent the morning playing at home before I took them to the Pomeroy Center for a swim from 1:40 pm to 3:45 pm.

Given I was out most of the day with the kids, we enlisted help from our babysitter to watch over the kids from 4 pm to 6:30 pm. Though the childcare window was relatively short, it afforded my wife and me the precious time needed to focus on my second book with Portfolio Penguin. The deadline for submitting the completed manuscript loomed.

But at 6:15 pm, a sharp scream pierced the air. Crying isn't unusual in our home, but this time, it felt notably intense. The babysitter promptly texted, explaining that our kids were roughhousing, and our son had inadvertently pulled our daughter's left arm.

While her arm didn't appear broken, she was having a really hard time staying calm. Given their frequent play-fighting, we initially didn't consider this latest incident a cause for much concern.

Past Regret Of Not Going To The Emergency Room

At 6:24 pm, my wife went downstairs in an attempt to calm the situation. Unfortunately, every time our daughter attempted to move her arm, she yelped in pain. Because the crying had stopped, I joined them at 6:55 pm, finding my wife in our daughter's bed reading a book. As soon as I entered the room, our daughter burst into tears. It was evident that something was seriously wrong.

When I inquired about her pain, she tearfully confirmed its presence. Then, upon asking if she thought we should head to the emergency room, her response was a loud and distressed refusal. She didn't want to go, and truthfully, neither did I. It was nearly 7 pm, approaching their bedtime.

Recalling an incident from my own childhood when I broke my left pinky toe at the age of 11, I hesitated. Running around the house barefoot, I had stubbed my toe so forcefully that it bent completely sideways. When I approached my dad and explained the situation, he responded with frustration, asking if I wanted him to take me to the hospital.

Regrettably, I chose not to go, feeling guilty for bothering him. Had I sought medical attention, they likely would have splinted my toe, allowing it to heal properly. Instead, my toe remains crooked and prone to injury, causing on-and-off discomfort for the past 35 years.

Another Trip To The Emergency Room We Go

Recalling my childhood trauma, I made the executive decision for all of us to head to the emergency room, just in case something was seriously wrong. Despite my son's protests and tears due to fatigue, I insisted he come along.

Despite repeated admonitions to be gentler with his younger and smaller sister, he hadn't heeded our advice. This incident became a teachable moment of three lessons.

Lesson #1: Actions have consequences. If you don't want to go to the hospital, endure tiredness, and witness your sister in pain, refrain from hurting her or playing too rough.

Lesson #2: We do not harm those we love. Instead, we treat our loved ones with care and respect, even though, unfortunately, we sometimes hurt those closest to us the most.

Lesson #3: Time is money. The repercussions of his actions mean Mommy and Daddy will have to work extra hours to cover the emergency room costs. He will be doing some work to help pay for the expense as well.

There is no way our son will not remember the lessons from this evening. As a result, hopefully his behavior will improve.

Drawing from our past experience with ambulance billing, I chose to drive, saving us $3,500+ or, at the very least, months of battling with the ambulance and insurance companies. We knew precisely where to go. There was no need to wait for an ambulance either.

The Injury And Fix

After dropping off my wife, daughter, and son at the ER at 7:15 am, I parked the car across the street and walked over. Seeing that my son wasn't doing well, I took him back to the car to decompress, explaining that the wait would likely be 2-3 hours based on past experience.

Cost of going to the emergency room and treating Nursemaid's Elbow

Fortunately, the emergency room wasn't too busy that evening. After an hour of waiting, the doctor examined our daughter's arm and suspected it was a common dislocation known as nursemaid's elbow.

The doctor performed a simple adjustment, and felt her elbow click back into place. Though our daughter cried initially when the doctor moved her arm, she instantly felt better.

The doctor left for 15 minutes to allow our daughter time to recover. Within a minute or two, my wife noticed our daughter was bending her injured elbow to tightly hug her lovey, which my wife had smartly brought along, along with iPads for distraction. When my wife asked our daughter how her arm felt, she calmly said “it feels better” with a sweet smile.

Thrilled, my wife scooped her up, flagged down the doctor and told her it worked! We then asked our daughter to show the doctor she could move her arm, but she initially refused. However, when the doctor requested a high five with her injured arm, our daughter complied. It was a moment of relief that brought big smiles to all our faces!

No X-rays were needed. Hooray! That's at least $200 saved, I thought to myself, plus no worries about getting a cast.

The Cost Of Going To The Emergency Room

Going to the emergency room is akin to enduring two kicks to the groin, stemming from concerns about both the person's health and the associated costs.

My five-minute hesitation in taking our daughter to the emergency room primarily revolved around the potential expenses and inconvenience, compounded by uncertainty about whether she was simply feeling particularly whiny after a long day.

If the cost of going to the ER were nonexistent or reasonable, I would hesitate less. However, if this were the case, it's likely that everyone else would follow suit, potentially overwhelming the ER with visitors.

The anticipated cost of this ER visit is around $1,100, despite currently paying $2,300 a month for an unsubsidized insurance plan, specifically a Select Plus PPO Gold plan.

The breakdown of the $1,100 ER visit is as follows:

$500 In-network plan deductible

$250 ER Network Per Occurrence co-pay

$150 estimated for 20% co-insurance for outpatient services in-network. Our insurance company estimates the cost of an ER procedure for nursemaid’s elbow is roughly $670, but this ultimately varies by provider.

$200 for triage. We're uncertain if the hospital will additionally bill us for triage when they initially took vitals, so this is an estimate.

While we are immensely grateful for the doctor who corrected our daughter's elbow, paying $1,100, especially after spending 2.5 hours on babysitting to work on my book, is hard to swallow. I think about how we should have continued to look after our kids and not “take a break” by working. Instead, we should have worked on the book after our kids went to bed.

At least we decided to go to the ER that evening instead of wait until the next morning. That would have been hours of misery as our daughter probably would have woken up multiple times until we had to go in the early morning.

Related: How To Get Subsidized Health Care Insurance As A Millionaire

The Cost Of Being A Parent May Be Higher Than You Think

The more children you have, the higher the likelihood of encountering challenges. As a parent, a lingering sense of apprehension often creeps up, anticipating that something may eventually go awry. The true health of your child may also not become apparent until they reach around 16 years old.

Reflecting on my own childhood in Taipei, at the age of eight, I experienced two overnight hospitalizations due to severe allergic reactions, marked by red spots and intense breathing difficulties. Despite the challenges, my mother's comforting visits, complete with my favorite He-Man figurine, provided solace during those trying times.

Around the age of 3.5, children tend to become more aware, offering parents a sense of relief that major accidents are less likely. By the age of 5.5, most kids should exhibit a degree of self-sufficiency. However, as they engage in vigorous activities like running and roughhousing, injuries become more commonplace.

I must redouble my efforts to replenish my savings, depleted by our recent home purchase, and prepare for impending property taxes and private fund capital calls. Life is currently on hard mode and I'm hoping there won't be further unexpected expenses.

Navigating the path to financial independence as a parent proves challenging. Yet there's no alternative but to persevere because we have no choice.

For those of you considering children or having another, I share this incident to help you see a bigger picture of the struggles parents face. The cost and time required to raise children can be immense. At least get your finances in order before you have them.

Related: Reach A Net Worth Goal Before Having Kids

Tips On Affording The Emergency Room And Minimizing Stress

Skip the ambulance for non-life threatening emergencies.

Skip the ambulance if you are able to drive safely and quickly to the ER. It might take an ambulance 5-15 minutes to get to where the emergency is and another 5 minutes to load you in and go. Then there's the exorbitant cost of riding in an ambulance to deal with.

Also investigate if there are Urgent Care centers close by and inquire what type of capabilities they have. Urgent Cares may be good enough and cost less than an ER visit if you do your research.

Map out the exact location of the closest ER and second-closest ER.

When you're dealing with an emergency, your brain can sometimes malfunction without proper pre-mortem planning. Save the ER addresses in your phone and maps app. Map out the near best Urgent Care center as well.

Build an emergency fund equal to six months of living expenses or more.

Depending on your healthcare provider, how much insurance you've used, and your status, visiting the ER would get extremely costly. Your emergency fund will help blunt the financial cost, but it will still hurt.

Call your health insurance company today and ask what type of coverage they have for ER visits.

Ask about your deductible, co-pay, and co-insurance. Ask them to run various scenarios so you can better budget potential future ER expenses. Do the same for Urgent Care.

Shop around for different plans.

During the next open enrollment period, carefully compare health insurance plans and forecast your future medial needs to try and save money. If you know you have something big coming up, like surgery, you may want to get a higher end plan with a lower deductible.

Ask your doctor about various options.

Trust your doctor's advice given they've seen all types of emergencies and generally have a good idea what to do. However, feel free to question whether some procedures are necessary to save money. Ask about the risk and reward of doing something and not doing something.

Have more than one backup for childcare.

Having one regular babysitter may not be enough given they may be traveling, sick, working, or simply busy. Have two or more people you can turn to for childcare support, including your friends, fellow parents, or neighbor if relatives are not around. Befriending your neighbor is a great move.

Talk to your kids about body awareness and safety.

Even though your kids might not listen, talk to your kids about safe play. If you have an older sibling, make them understand they cannot play as rough with a younger sibling due to size, strength, and developmental differences.

Given all the information and tools necessary to your childcare provider.

Give your childcare provider some things to look out for to help minimize injury, e.g. allergic to certain foods, sprained body part, lack of body awareness, etc. Print out a list of important telephone numbers to call in case of an emergency, e.g. 911, your number, your partner's number, backup childcare person's number, close friends and relatives, your neighbors.

Pay closer attention as a parent and be stern when the risk increases.

Being an engaged parent for long periods of time takes tremendous effort. It's easy to zone away on the phone while your four-year-old is dangling precariously from a tree limb. We must try our best to remain engaged, especially in environments that could be dangerous.

Pools and the ocean are two of the most dangerous environments for beginning swimmers or non-swimmers. One look away and disaster could strike. Teaching your kids to swim is one of the best exercises for building a parent's childcare endurance. It’s also vital to reduce the risk of drowning.

Reader Questions and Suggestions

Have you gone to the emergency room lately? If so, what happened and how much did it cost? How did you end up paying the bill? Is there a better way to save money on a ER visit?

If you're looking for affordable life insurance, check out Policygenius. Just fill out your information and Policygenius will find customized life insurance quotes to meet your situation.

Both my wife and I used Policygenius during the pandemic to get matching 20-year term life insurance policies. After we did, we felt a tremendous sense of relief because we know there won't be any forced selling to care for our children in case something were to happen to us.

For more nuanced personal finance content, join 60,000+ others and sign up for the free Financial Samurai newsletter. Financial Samurai is one of the largest independently-owned personal finance sites that started in 2009. 

58 thoughts on “Going To The Emergency Room Is Like Getting Two Kicks To The Groin”

  1. I am a family physician! My father did this to his grandson (my son), he had picked him up and was swinging him around, then he stopped using his right arm. My dad was scared to death, I immediately fixed it in our family room and continue to harass my father about it! This is where it helps to know a physician, because the system is set up to profit from panic. Calling an ambulance for this would be ridiculous, but the parental fear instinct kicks in so I understand. My wife is a pediatrician and in our old private practices we addressed many things that were urgent and squeezed into our schedules. After hours we would have taken your phone call and helped you make the best decision for your child (and financially for your family). I am in my early fifties and have pivoted to a digital health management position, but I think a reasonable fee based digital practice that steers patients to quality affordable care would be something patients would flock to. For example, the hospital I worked for would not provide a cheap in office flu test so I would use their laboratory and the $500 flu dna swab. Insured patients more and more have high deductible health plans and are paying cash for services. I was telling them to go to Walgreens for a $20 flu/covid swab, these work arounds are needed and physicians know the game and are best positioned to be financial advocates for our patients. Thank you for everything you do! Long time follower of your site and now sharing links to my children as they graduate from college and start their careers!

  2. 2 of my 3 kids have had nursemaid elbow! We took them to urgent care. One of the kids was the 3% of the kids where the simple adjustment just didn’t work, had to wear a cast for 5 days. I’ve since been told there are plenty of videos on YouTube that show you the simple technique of how to fix it , I’ve also watched a nurse friend perform it on her child after she screamed everytime she moved her arm after a piggy back ride. So stressful to watch our kids in discomfort!

  3. I can empathize. We called our daughter Miss Deductible as each year typically by April, we had met our family deductible due to her sports injuries. Perhaps as a result of all those medical treatments she is now a physician and proudly shows her smaller patients some of her scars.

    Healthcare in our country is broken. Many are one injury away from loss work, bankruptcy and possible homelessness. Basic healthcare should be more fundamental than the 2nd Amendment, but alas many of those that support the latter are vehemently against the former. I’ve had several conversations with some of my more conservative acquaintances to try and understand their position as well as present some facts supporting healthcare. Unfortunately, their counter starts and ends with cries of Socialism, which in most cases they cannot rationally define.

    I am old enough to recall employer provided healthcare being a ‘given’ that I and many took for granted. Now plans that small employers can find and afford, typically do not provide much in the way of actual coverage for any serious illness.

    I hope you and your family remain healthy and your lessons in healthcare remain affordable.

    1. “ Perhaps as a result of all those medical treatments she is now a physician and proudly shows her smaller patients some of her scars.”

      Love this! Having a doctor in the family is very impressive. You must be very proud.

  4. So glad your daughter’s condition was fixed almost immediately. Thanks for the pointers on preparing for unexpected expenses. I was fortunate to have my employer’s health insurance covering a major chunk of my ER bills. I’m opting to work so I can continue to take advantage of the employer’s healthcare coverage. Oh btw there’s a typo on the time of your daughter’s visit to the ER. I think you meant 7:15 PM.

  5. Janice Murray

    Hello Sam
    I’d like to comment on your Emergency room article. I was an RN in a busy Level I Trauma Center ER for 34 years. There is a significant amount of people who use the ER as their primary care who are referred to as frequent flyers who do not have insurance. In regards to ambulances. There is also a population who are also uninsured and call an ambulance for a ride to the hospital, who feel they will move to the head of the line if they arrive by ambulance. These individuals generally do not pay for the ambulance services and the medics cannot refuse them care or transportation to the ER. Only a few reasons for the skyrocketing costs of healthcare.

  6. Dood, el Farbe

    Hi Sam, sorry to hear about your family’s medical difficulties, but glad they worked out well.

    I had a trip to ER via ambulance a few years ago. That one was covered by insurance. Then I had ambulance transfer between hospitals, because the one they took me to first couldn’t handle my level of trauma.

    Drugged to the gills, I just said sure, take me there. Assuming it was covered.

    Instead, it was an ambulance company that doesn’t take any insurance. A 4-mile, about 7 minute transport was supposedly over $4,000. I was back home at that time, confined to a wheelchair and my easy chair, and gave them a call. Once their rep pulled up my case, she confirmed it was $4K. I explained they could sue me or sell it to a collection company, I didn’t care which, I wasn’t paying over $1000 per mile for their services. She asked if I had a credit card on me and would $300 work. I gave her the CC number and code and we were done.

  7. As an ER physician and owner of four urgent care clinics, I’d like to add a few suggestions to Financial Samurai’s Tips On Affording The Emergency Room And Minimizing Stress.

    1. Know Your Local Health Care Options
    In a true emergency, time matters. If your condition is life-or-death, you always want to go to the nearest ER. If they can’t handle it, they’ll stabilize and transfer you. In these situations, you shouldn’t worry about money. For non-life-threatening conditions, you generally have time to travel to the most appropriate place to receive care without taking an ambulance. Make a map of all ERs and urgent care clinics within your area. Learn what your local urgent care can treat and utilize them when appropriate.

    2. Understand Your Medical Insurance
    The first step is to understand how your medical insurance works. You can find information on your insurance card, and a glossary of terms can be found at https://www.healthcare.gov/sbc-glossary/. Your insurance company’s network is the most important thing to understand if you want to save money.
    Unfortunately, this may take some legwork on your part. Start with finding out which hospitals in your area are in-network with your insurance company. Next, call each hospital to ensure the ER physician group is also in-network. You may have to work for it, but stick with it until you have the answers.

    3. Have Someone to Ask
    If unsure, have someone help you choose the appropriate level of care. Find a doctor or nurse among your family, friends, and acquaintances. Don’t abuse the privilege, but most of us don’t mind a legitimate question, especially if it’s on where to go. If Financial Samurai had texted me, I would have advised an UC visit instead of the ER for a suspected nursemaid’s elbow. If you don’t have anyone to call, go with any local resources, such as a local nurse hotline.

    4. Have an Emergency Fund and Some Perspective
    I agree with the tip recommending an emergency fund. An ER visit for a severe illness or injury is the definition of an emergency. Financial Samurai did the right thing in immediately taking his child to the ER as anaphylaxis can be life-threatening. We can discuss whether we should have universal healthcare coverage, but for now, we must deal with the reality of our current US system. I regularly see people die in the ER, and, this unfortunately occasionally includes children. Accept that emergency healthcare in the US is expensive and be thankful that you have a fund to cover the cost and are alive to utilize it.

    1. Sam and Neill,
      What a timely topic! I never wrote here but feel compelled to do so. Last year my husband had some sharp back pain, so we called the NYU Langone find a doctor hotline to see if we can see an in-network doctor right away. We were referred to NYU Langone’s Samuels Orthopedic Immediate Care Center which was later understood as an Urgent Care facility. No x-ray or big procedure, just walked out with painkiller prescription and a patch. We paid a $200+ physician fee after insurance, but were not aware there is an additional $1,236 facility charge. We are currently in dispute with NYU as we were not informed about this high facility charge during admission. As I understand, urgent care should be more economical than ER, so why is there such a costly facility charge? In google reviews, we read a few angry patients who have similar experience of this surprised billing towards this facility and only a 2.4/5 rating. We tried to file a complaint with the Surprise Act in NY State but was told this facility is an in-network facility and they only deal with out-of-network cases. We’ve then submitted a complaint to the NY General Attorney as we feel that there should be more consumer protection. Would appreciate if anyone can help me understand if $1.2K facility charge is a normal cost for urgent care (not ER)? Being in COBRA now, it pains me to pay this bill.

      1. Amy,
        I’m sorry this happened to you. It sounds like you went to a hospital owned urgent care that is part of a “health system.” A hospital can become designated as a “health system” and then charge a facility fee at select outpatient facilities, including doctor’s offices and urgent care clinics. They can then charge you a facility fee like you went to the ER. This is one of the reasons that hospitals will buy physicians private practices, specialists offices, and urgent care centers (the other is as a funnel for profitable hospital admissions, procedures, and surgeries).
        To avoid this you can go to a privately owned urgent care as they cannot charge a facility fee. To complicate matters further, not every hospital owned UC is part of a health system, so you will have to ask upfront if they charge a facility fee. Sometimes you can tell by the name of the hospital – Generic City Hospital vs Generic City Health Systems, but I would always ask.
        According to the Urgent Care Association of America’s 2023 White Paper, the average ER bill in 2021 was $1,646, while the average UC bill was $171. The same paper states that in 2023, 33% of urgent care clinics were owned by hospitals or joint-ventures with hospitals.
        Other entities that can charge you a facility fee are Free-Standing Emergency Rooms. These facilities often look like urgent cares but are not. In some states they can be separate for-profit companies, but in most states they work under the hospital system. Either way, if it says “Emergency” in the name anywhere – ER, Emergency Room, Emergency Center, or EC, think of it as the hospital ER when it comes to prices and billing. They purposefully promote that they are available for “minor illness and injuries,” and many people are confused thinking that these are urgent cares when they are not. They look nicer and are often faster and more convenient than a hospital ER, but the price will be the same or higher.
        Thank you for bringing this up. I should have mentioned it in my original reply. It’s a minefield out there. Be careful!

        1. Thank you so much Neill for these insights. Had we been informed upfront there was a facility charge during admission, quite sure my husband wouldn’t pursue further as his case was not life threatening. It’s very sad to see how profit seems to be the driver behind these new waves of outpatient acquisitions into the “health system” to justify these higher cost. These days verifying if the doctor is in-network is no longer enough as one has to spend time doing a full research.

          I did have a lengthy discussion with my insurer and they have suggested me try to negotiate down the facility fee w/ them. Will we stand a chance?

          I’m currently in Portugal and I heard a good private health coverage costs <200 eur/mth. I also had a ER experience a few years back while traveling here w/o local insurance, and it only cost me less than 300 eur including ambulance. Something is very wrong with the US health system!

  8. You touched on it but I would like to emphasize this is not a life threatening injury requiring use of an emergency room. Nor would this be anywhere close to utilizing an ambulance. Both of those resources are for life threatening issues such as the allergic reaction you experienced a couple years ago. A little bit of research and planning would avoid you alot of wasted time and money. Find out your closest ER, your closest Level 1 trauma center (only go to a level 1 trauma center for life threatening trauma), urgent cares, pediatric ER, pediatric urgent clinics. Also, learn what hospitals have certain resources such as pediatric ICU’s, cardiac/stoke specialties. In my area, we have pediatric orthopedic clinics for which you can make appointments online, usually same day. We have utilized the pediatric clinics multiple times for broken bones. ER’s are very overloaded with non urgent issues hence the long wait times, out of control costs, and creation of urgent care clinics that are now on every corner. Like one commenter posted, utilize your pediatrician’s exchange, they are very helpful for us. Further, no way you could have prevented this, it is very normal kid stuff. They are doing what they are supposed to do, which is playing together and learning limits/boundries. This will not be the last of the kid injuries, I promise.

  9. Matthew Drybred

    An HSA should cover these expenses.

    As a commenter already mentioned, HSA’s are a great way to save money that is tax-free for healthcare expenses.

  10. healthcareprofessional

    I am not sure how your plan works, but I wonder if you can go to Urgent Care instead for such cases? They usually are much cheaper, and wait time is less. But the hours are not that flexible. My insurance definitely encourages the use of Urgent care Vs. ER visit. Just a thought, wishing a speedy recovery for the little one

  11. Frank in Las Vegas

    The ER and healthcare costs can create a big problem for sure.
    Sine so many of your readers are working hard, building their nest eggs, perhaps they will fare better than others.
    The good news is that since so many of them are undoubtably eating healthy, exercising and living longer they can look forward to their hard earned money being swallowed up by a long term care facility.
    The costs are astronomical. It is not uncommon to spend 13-15k per month per person.
    Multiply this times two for a happy couple that looks forward to living in their late 80,s or 90’s and it wont take long to burn through 2.5-3M dollars. Keep burning up a hard sweat and eating that kale and tofu !!

    1. Keep on working so you have 3m to waste (spend) in your 80’s on an old-folks home? It really is getting to the point where you need to retire early, live your life, and jump off a balcony when you get to the point you need the old folks home.

  12. Medical costs are one of the reasons that I will continue to work until age 65, I am 60 now. In addition to two years of cancer treatments and operations, my son, who has a peanut allergy, was served the wrong smoothie at tropical smoothie. It contained peanuts. We brought him to the emergency room and that resulted in a night in the ICU and a breathing tube—total cost for that alone was $30,000. Fortunately tropical smoothie covered the $5000 out-of-pocket that I would’ve had to pay.
    My cancer treatments and operations were probably in the vicinity of half 500K.
    Fortunately, my company has an out-of-pocket maximum of $7500 per year. For many years, I didn’t appreciate my medical insurance because it seemed like I was paying a lot of money for routine visits to the hospital. I now realize that for catastrophic type illnesses it is absolutely necessary as it can financially sink most people otherwise.

      1. Well…that’s not exactly true. I’m retired and we receive extraordinarily affordable healthcare via a subsidized ACA plan; it’s far cheaper than any coverage I ever had at any job. The key is maintaining a relatively low income and corresponding lifestyle. For those who have chosen FatFIRE this likely isn’t doable. Even then a full freight ACA plan should be affordable, it just needs to be calculated as part of the “fat”, and will prevent catastrophic financial impacts.

        ps. Be happy you weren’t the one who partially dislocated your daughter’s elbow. I accidentally did that to my son 15 years ago while helping him get up from the ground and faced some very pointed questions in the ER after the doctor did the quick move to fix it. Thankfully my wife was also present so we able to “prove” to the doctor that it was an accident rather than child abuse.

  13. Ahh the old nrsemaids elbow. Such an easy fix when you know how to do it. Some thoughts….consider calling your on call pediatrician, urgent care, or orthopedic urgent care for these types of injuries. Sometimes, as parents, we freak out and go to the ER when it is overkill in many cases. I started considering the ER for life threatening health emergencies only and this is the way that our insurance overlords want us to think. Now please stay healthy for a while!

    1. Got it. How would you suggest parents fix the nursemaids elbow when they have never encountered it before? Do you think it’s worth googling the problem and doing some experimentation? I just feel it’s a little bit tough because what if we make it worse? And our daughter was screaming whenever she moved the elbow.

      1. Not suggesting you should know how to do it or do it yourself, but if you did learn you would be amazed at how simple the fix is.

  14. Would it have been cheaper to pay out of pockets instead of paying for insurance and hoping they’d cover some of this?

  15. “Life is currently on a hard mode.” Your words. You reference your recent home purchase……. I suggest that ER visits are a bummer but part of life. So are property taxes which you also reference. Perhaps your self imposed destruction of your hard earned financial independence has made not unexpected expenses like medical bills and property taxes somehow more onerous? Be careful what you wish for,,, FOMO( your words) always costs more than you think.

    1. It’s more about raising two young children. Takes time, worry, energy, and money. But yes, the extra cost is a bummer.

      How has raising children been for you? Being a stay at home dad for the past seven years has been the toughest job I’ve ever had had.

      So I’m always interested in hearing different perspectives from other dads, especially stay at home dads.


      1. We raised two daughters. One earned BS/ RN degrees. The other earned her Pharm’d degree. They went to good, not the best schools. They were raised in a nice but not noteworthy neighborhood. We spent every summer aboard our boat sailing the bay and coast together. Now are retired and our withdrawal rate is zero. We had medical bills and property taxes and all the rest. We just stayed true to keeping it simple and remaining financially independent.

        1. Good stuff. Did you retire early as well and spend years being a stay at home dad?

          If not, do you have any regrets not spending more time with your children? It always seems to be a push pull that all between working and spending time with them.

          My strategy was to be a SAHD dad until
          They went to school FT. And I’m wondering if this makes logical sense.

          1. Self employed both of us) and worked from home before that was a thing. Drove daughters to school until they got (old) cars . Spent more time with them than the probably wanted. We were semi retired the whole time because our wants and needs were simpler than most. Same house since 1989. Same boat since 1999. Most expensive car we ever bought was 24.5k.

            1. Cool. Yeah, it’s been gratifying being a stay at home dad since 2017. Now that both kids will be in school full-time this fall, I’m going to join you in semi retirement by doing some consulting for 1 to 3 years.

              I really enjoy living in the nicest house I can afford and driving the nicest car I can afford within my rules. Having these two items, good food, education, health, time, and freedom are what I value most.

              That’s great that you’re happy living simply. Everything is rational and we decide on things that we want and take action.

  16. Chuck Sarahan

    Your story is no surprise to me. Nearly buying it at least two times, here are three comments for you:

    a) The comment about ambulance care is spot on. A lot are owned by private equity which may explain why they are exempt from surprise billing limitations. If you have a local fire department take you, this should not be an issue.
    b) Learn the difference between a selfstanding ER and one attached to the hospital. Actually, there is not a lot but people go to the latter and often ignore the former. I have had enough experience that I try to go to the former unless having a heart attack (been there done that).
    c) For yourself, learn the difference between a level five trauma provider and a level one. Lower is better but not always needed. As you get older, this gets more important.

  17. You made a good decision to bring your son along to the ER despite his complaints. Good way for children to experience the consequences of his actions.

    > “I think about how we should have continued to look after our kids and not “take a break” by working. Instead, we should have worked on the book after our kids went to bed.” – Don’t beat yourself up over this. Kids need to gradually learn to regulate behavior even without an adult constantly hovering around them. But yes, it can be a stressful and expensive process.

    1. Might as well make lemonade, and create a teachable moment, right?

      Hopefully, everything is rational, and my kids will understand the consequences of their actions.

      Failure is a great teacher. In addition, anytime he starts whining about wanting something I don’t think he deserves, I can tell him he still needs to help pay off the $1100 expense.

  18. You should look into fixed indemnity insurance (Sidecar Health is one option). I’ve used that for a family of four and not only is the deductible lower but it would almost definitely cost you less than traditional insurance. Would be interesting to see a comparison.

  19. Glad your daughter is OK.

    We’ve had the experience of calling the urgent care and making sure they could see her, going to the urgent care, and then having them telling us to go to the ER, and getting billed by both!

    My wife recently had to go to the emergency room and get transported downtown, and stay for 3 weeks across 3 hospitals. Because she’s on disability though, we don’t pay anything, but that could have been very costly. We almost went back this weekend, but luckily, an on-call doctor and a 24 hour pharmacy that I drove to help keep things stable at home.

    1. The situation of going to urgent care, paying for the cost, and then having them send us to ER definitely crossed my mind. So I decided to bite the bullet and go straight to ER. But maybe for this nursemaids elbow fix, it would have been a fairly simple procedure.

      It’s just hard to know in the moment when your child is screaming and crying.

      I wish your wife a speedy recovery, and better health!

      1. Whew! Sam! Thanks for sharing this! It falls into the category of “these things
        Happen!” So don’t overthink it!! It’s probably a good idea to cut out the play-fighting at this point!
        (Mom of 4 here!) it’s all fun until someone gets hurt!!

        Your son is probably just too rough at this age and is going to push boundaries-it’s normal at this stage.
        That said-don’t go too hard on the punishment and guilt-kids getting hurt sometimes is a normal part of childhood and we don’t him to best himself up too much over this.

        My daughter had a the same thing happen at a picnic when my husband gently pulled her over to get ready to leave. It is very
        Intense Pain-and you really have to get medical help!

  20. Oh man what a tough break but hey I’m glad your daughter had a quick recovery. That’s way better than having a fracture and needing to get a cast. I can’t even imagine how many hours that would have taken.

    This talk of hospital stuff reminds me of a mom I talked to once who has 3 boys. She was telling me how she was in the ER so often because her boys were always getting hurt that the ER team knew her by name. So yes, parenting is tough and even though kids bodies are pretty resilient, they have their limits too.

    Hopefully no more trips to the ER anytime soon. Makes me further appreciate the doctors and nurses who work in them day after day! They must have so many stories to tell.

  21. You should consider the maximum out of pocket costs that all ACA compliant plans have as well. I recently went from a low deductible to a high deductible plan with a HSA this year and my deductible for in-network (United Healthcare managed plan) is an outrageous $3,200. With some scheduled surgeries coming up it looks pretty dire. Fortunately, I have an out of pocket in-network maximum of $5,000 so I still come out ahead with the money I’m saving on premiums that’s going into the HSA instead. Have you done any articles on HSAs? They are really an effective way to back door retirement savings that often gets underlooked.

    1. Following the same strategy as you Brent. Bronze-level HSA plan and maxing out HSA contributions.

      Our family’s take on medical insurance is that it’s primary use is to cover medical expenses that would cause lasting financial damage. While an ambulance ride is certainly spendy, $3K isn’t that much money in the medical world. What worries me way more is an extended hospital stay where expenses can quickly reach 6 figures. Our family’s annual deductible is something like $13K; we’ve never come anywhere close to that (knock on wood!).

      Nice thing about ACA plans is they mandate that all preventative care (including expensive procedures like a colonoscopy) be covered 100%. I’ve read something about hearing aids being covered, starting this year, but haven’t researched that yet.

      1. Quick follow-up to the end of my prior message – it turns out there are only 6 states that mandate that insurance cover hearing aids for adults. I’m fortunate to live in WA. That’s $3000 per ear though it doesn’t cover OTC models. I’m guessing the audiologist lobby (if there is such a thing) pushed this through to boost business.

        Arkansas – $1,400 per hearing aid every 3 years
        Connecticut – $1,000 every 24 months
        Illinois – $2,500 per hearing aid every 24 months
        New Hampshire – $1,500 per aid every 60 months
        Rhode Island – $700 per aid every 3 years
        Washington state – $3,000 per aid every 3 years

  22. Robin Mason

    Just wondering
    I’m Canadian so an ER visit is free for me. Could you build a slush fund then get off health insurance and just save the $2100 in costs, save the money and maybe invest it and just pay for the odd ER visit? Would that be too expensive?
    Maybe that’s crazy?

  23. California Expat

    Glad your daughter is ok now, I feel your pain. All theee of our ER visits over the last few years have been ‘preventable’ injuries caused by siblings. It is unbelievably frustrating as a parent when this happens.

      1. Good point. That would add another groin kick.

        I’ll definitely be researching which facilities around me do what services so that, should the time come, I’ll know where to go.

  24. Fille Frugale

    My heart so goes out to you and your family, I normally don’t comment but feel compelled to do so here. I’m so glad your daughter is ok and hope your son will be more careful in the future. I’m a 52 y.o. woman who herself has experienced the joys of an ER visit 3 times so far – the 1st time for uncontrolled bleeding, which was misdiagnosed and resulted in a 2nd ER visit the next day (at which point my BP was in the 60/30 range and I had lost more than half my body’s blood supply); the 3rd time for severe chest pain which luckily was a lung infection and not a heart attack, or I would have died countless times between the time it took the ambulance to arrive (30 min, even though I live in the center of Atlanta and a 5 min drive away from TWO huge hospitals – but alas each time I couldn’t drive myself and all emergencies happened in the dead of night when I didn’t dare to call a friend) and the time in the ER waiting room to be given an EKG (another 30 min) – and wasn’t diagnosed until 6 hours after I showed up. Luckily, each time I was covered by my job’s health insurance and could easily pay the remainder. Now I’m FIREd and on cobra (which is actually *cheaper* than the ACA for my MAGI – so much for “affordable”) and have the *extreme* luck of being a dual US-EU citizen. Once cobra runs out, you can bet I’m hightailing it to Europe where I will gladly pay the necessary taxes for their healthcare coverage and where they don’t know the meaning of words like “co-pay,” “deductible,” “pre-approved,” or “pre-existing condition”. US healthcare is a crime against all Americans and I can’t begin to tell you how many friends I have who keep working well beyond their FI number because they have a tricky health condition and don’t trust the ACA. I will not be back in the US, which I love and to which I 100% owe my FIRE, until I’m eligible to Medicare. And I weep for everyone who doesn’t have the privilege of an EU passport. Sorry for the long rant, this one touches deep. All my very best wishes to you and your family.

    1. You may even want to reconsider moving back even with Medicare. The premiums for part B and D are not cheap and copays can really add up. Part B has a 20% copay and there is no cap. Many Americans opt for a Medicare Advantage Plan to reduce the copays but that forces you into a network which may not include the best hospitals/doctors.
      Fortunately I retired from the government and I reside in Mexico. My insurance treats all providers outside of the US as in-network so I truly can go anywhere I want. Mexico has numerous health care systems, including one that is completely free (albeit, limited). The best private hospitals are often much nicer than what you find in the US, given that they are entirely private and do not accept non-paying patients. Interestingly enough most of the doctors at the private hospitals also work for IMMS, which is the health care provider for those that pay into the Social Security System. US News and World Report actually lists a number of the IMMS hospitals very highly (just under the best private hospitals).
      The costs of even the best hospitals tend to be a fraction of the US cost. I just got a colonoscopy and the total cost was approximately $1200 at one of the best hospitals in San Pedro Garza Sarda (a suburb of Monterrey that is considered the Beverly Hills of Mexico). The doctor seemed pleasantly surprised when he gave me the results and there were no polyps. This is when I realized that preventative colonoscopies are rare in Mexico.

  25. Good to hear your daughter is better. Also, good move going to the hospital. You can afford it so it’s better to let the doctor take a look. We live 2 blocks from the ER so I don’t foresee calling an ambulance unless it’s life-threatening.

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