Consumer6 min read8/19/2026

Emergency Room Visit Without a Referral: When Fees Are Waived and How to Obtain a Refund for an Amount Paid

A bill issued by the emergency room does not always mean that the patient must pay it in full. Under the State Health Insurance Law, the exemption may be full or partial, and the health fund may retroactively recognize that the independent visit was medically justified.

Numbers and facts

•01:00–06:00 — payment of the fee only for an independent nighttime visit
•38.5 degrees Celsius — the high-fever threshold for an infant
•Up to two months old — age-based eligibility in the case of a sudden fever
•Up to two years old and over 70 years old — eligibility in the case of a head injury
•Third degree — a burn that grants a full exemption

What an Emergency Room Visit Bill Consists Of

The fee for an emergency room visit consists of two parts: the emergency room fee and the cost of the treatment provided. A full exemption cancels both parts, while a partial exemption cancels only the cost of treatment, and the fee itself remains payable. If a person arrived without a referral and the reason for the visit was not among the specified circumstances, the health fund may require full payment according to the Ministry of Health tariff. The exact amount depends on the applicable tariff and the circumstances of the visit; the materials provided did not state the fee amount in shekels.

When No Referral at All Is Required for a Full Exemption

Patients who were hospitalized after the examination are fully exempt from payment, even if they did not have a referral or Form 17. The same rule applies in the case of a recent fracture; acute dislocation of a joint or the jaw; a wound requiring stitches or another closure method; a foreign body in the eye or respiratory tract; a snakebite; a scorpion sting; or a life-threatening allergic reaction. The list also includes a third-degree burn, labor, an epileptic seizure in a patient with epilepsy, treatment of a cancerous disease, hemophilia, cystic fibrosis, familial dysautonomia, and dialysis. The exemption is also granted following a head injury in a child up to two years old or in a person over 70 years old, as well as in the case of a sudden fever above 38.5 degrees in an infant up to two months old. The full exemption also applies to victims of domestic violence or sexual violence.

A Document May Determine the Outcome

In the case of a work injury, a document from the employer is required—National Insurance Form BL/250; in the case of a road accident, a police report is required. A student injured at school or during a school trip needs confirmation from the educational institution. A full exemption is also granted to a patient who has a medical referral or Form 17, if the patient was not hospitalized. Another independent ground is evacuation in a Magen David Adom vehicle from the street or another public place following a sudden incident. Merely arriving in any ambulance does not guarantee an exemption, and evacuation charges are examined separately from the emergency room bill.

When Only the Emergency Room Fee Remains Payable

If the patient arrived independently between 01:00 and 06:00, the patient pays only the emergency room fee, even when the reason is not included in the list of circumstances granting a full exemption. At any time of day, the health fund may determine after the visit that the referral was medically justified; in that case, the cost of treatment is covered, but the fee remains payable. For the assessment, the fund examines the medical summary issued by the emergency room, so it is important that it document the complaints, when they began, the test results, and the treatment provided. The patient’s concern alone does not substitute for medical justification, but the absence of a diagnosis from the automatic exemption list does not automatically require full payment.

How to Challenge a Bill That Has Been Issued or Already Paid

After an independent visit, the emergency room discharge letter and payment receipt must be submitted to the health fund’s reception desk. If the fund recognizes that the visit was justified, it will issue a payment undertaking—Form 17—in favor of the hospital. The form received must be transferred to the hospital’s collection department with a request to recalculate the amount, and if the money has already been paid, the relevant institution should be asked about the refund procedure. The Ministry of Health emphasizes that responsibility for contacting the fund on time and completing the settlement of the undertaking rests with the patient. A verbal conversation with the fund is not enough: the discharge letter, receipt, Form 17, and proof that it was submitted to the hospital must be retained.

Mistakes That Lead to Loss of Eligibility for the Benefit

A common mistake is to assume that every nighttime visit is fully exempt from payment: the hours from 01:00 to 06:00 generally exempt the patient from the cost of treatment, but not from the emergency room fee itself. Other mistakes include failing to obtain a police report regarding a road accident, confirmation from the school, or Form BL/250 in the case of a work injury. The health fund is also not required to issue Form 17 retroactively if the visit was not urgent, was not included in the list of benefits, or related to treatment planned in advance. A hospital bill should not be ignored in the expectation that the data will be transferred automatically: for example, Wolfson Medical Center explicitly states that the fund needs the emergency room discharge letter in order to issue the undertaking.

FAQ

Must I pay the emergency room fees without a referral if I was hospitalized?

No. Hospitalization after the examination grants a full exemption from the emergency room fee and the cost of treatment, even if the patient arrived without a referral and without Form 17.

Can Form 17 be obtained after an emergency room visit?

Yes. You may contact the health fund with the emergency room discharge letter and the receipt. If the fund recognizes that the visit was medically justified, it will issue an undertaking in favor of the hospital, but in the case of a partial exemption, the emergency room fee will remain payable.

How can I obtain a refund if the bill has already been paid?

First submit the medical summary and receipt to the fund, then obtain its decision and, if the request is approved, Form 17. After that, contact the hospital’s collection department with the undertaking to have the amount recalculated and to inquire about the refund procedure.

Does evacuation by ambulance exempt the patient from paying the emergency room fee?

A full exemption is granted in the case of evacuation in a Magen David Adom vehicle from the street or another public place following a sudden incident. The evacuation charge itself is settled separately: for example, a full refund is granted in the case of hospitalization following evacuation, while no refund is generally granted in the case of evacuation by a regular ambulance without hospitalization.

Can I avoid paying the full bill if the visit took place at night?

A visit between 01:00 and 06:00 in itself exempts the patient from the cost of treatment, but not from the emergency room fee. A full exemption may be obtained if one of the specified grounds also exists, such as hospitalization or a recent fracture.

What to do next

Gather the emergency room discharge letter, the receipt, and the document proving the existence of a special ground for the benefit, and submit them without delay to the health fund. After obtaining Form 17, submit it to the hospital’s collection department and retain proof that it was sent; if payment has already been made, separately request recalculation of the amount and instructions for obtaining the refund.