Why is this soooo hard?

Conversation with a patient with low back pain:


Me: You have a couple of options. If the pain is not severe, I can make you an appointment to see an Orthopaedist in a few days. If you can't take the pain anymore, there is an emergency clinic that is open until 9 tonight. Both options will only cost you your $20 co-pay.

Him: Well, why did the hospital charge me $400 when I went to the ER?

Why did you go to the ER?

I had a bug bite.

You had a bug bite that resulted in a severe allergic reaction? Trouble breathing...throat closing...?

No, it just itched

If you go to the ER and it's not an emergency, your insurance doesn't pay. You have to pay.

Well, what is an "emergency?"

An emergency is where you are in danger of losing your life or a limb, NOT a bug bite that just itches you idiot!

OK, so I didn't say that the idiot part. But I REALLY wanted to! Why is this sooo hard to understand?