Switched from urgent care – and toward a big emergency bill

This article by Sam Whitehead first appeared on Kaiser Health News

September 29, 2022

Frankie Cook remembers last year’s car accident in only flashes.

She was driving a friend home from high school on a winding road outside of Rome, Georgia. She saw stagnant water from the last rain. She tried to slow down but lost control of her car on a large curve. “The car flipped three times,” Frankie said. “We turned around and drove off this hillside. My car was on its side, the back end smashed into a tree.”

Frankie said the airbags were deployed and both passengers were wearing seat belts, so she was left with a headache when her father, Russell Cook, came to pick her up from the crash site.

Frankie, then a high school student, worried that she might have a concussion that might affect her performance on the upcoming advanced placement test, so she and her father decided to stop at an urgent care center near their home to be examined. They didn’t get past the front desk.

Russell the receptionist said at Atrium Health Floyd Urgent Care Rome She told him, though he wasn’t sure what she meant. “She told me, like, three times.”

The problem does not appear to be that the clinic lacks the medical expertise to evaluate Frankie. Instead, it appears that chefs are faced with a reimbursement policy often used by urgent care centers to avoid waiting for payments from auto insurance settlements.

Russell was asked to take Frankie to the emergency room, which by law must receive all patients regardless of such issues. nearest one in Atrium Health Floyd Medical CenterIt was about a mile down the road and was owned by the same hospital system as the Urgent Care Center.

There, Russell said, the doctor looked at Frankie “for just a few minutes,” did CT scans of her head and body, and sent her home with her advice to “take some Tylenol” and rest. She did not have a concussion or serious head injury and was able to get an AP test on time.

Then the bill came.

the patient: Frankie Cook, 18, is a first-year undergraduate student from Rome, Georgia.

medical services: Medical evaluation and two CT scans.

Service Provider: Atrium Health Floyd, a hospital system with urgent care centers in northwestern Georgia and northeastern Alabama.

Total bill: $17,005 for an emergency room visit; It was later revised to $1,805 after the duplicate fee was removed.

What gives: Chefs are put at risk in the healthcare system after Frankie’s car crashes into that tree: More and more hospital systems have urgent care centers, which have restrictions on who they treat – both for financial and medical reasons.

Russell was very upset after receiving such a large bill, especially when he tried to make a quick and inexpensive trip to the clinic. He said Frankie’s grandmother was seen in an urgent care center after a car crash and walked out with a bill for just a few hundred dollars.

“That’s kind of what I expected,” he said. “She really needed to be looked at.”

So why was Frankie removed from the Urgent Care Center?

Lou Ellen Horowitz, chief executive of the Urgent Care Association, said it is a very standard policy for urgent care centers to not treat injuries from car accidents, even minor ones. “In general, as a general rule, they don’t take care of car accident victims no matter how severely injured they are, because they will go through the car insurance claims process before the provider gets paid,” she said.

Urgent care centers — even those owned by large health systems — often operate at meager margins and cannot wait months and months for an auto insurance company to pay a claim, Horowitz said. “Unfortunately,” she said, people tend to recognize such policies when they appear expecting care.

fold in The complex relationship between health and auto insurance companies and you have what Barack RichmanD., a professor of health care policy at Duke University School of Law, described the “extremely complex world we live in.”

“Each product has its own specs about where it’s headed and what it covers. Each one is incredibly difficult and complex to manage. And everyone errs on the system.”

Atrium Health did not respond to repeated requests for comment on Frankie’s condition.

Horowitz dismissed the idea that the health system might push people in car wrecks from urgent care centers to emergency rooms to make more money from them. However, auto insurance generally pays more than health insurance for the same services.

Richman remained skeptical.

“At the risk of looking a little cynical, there are always dollar signs when a health care provider sees a patient coming through the door,” Richman said.

Dr. Ativ Mehrotra, a professor of health care policy at Harvard Medical School, said it’s likely that the urgent care center is right down the street from the ER. Part of the strategy makes medical sense, he said, “because if something bad happens, you want to move them somewhere with more skills really quickly.”

But he also said urgent care centers are “one of the most effective ways” for a health system to generate new revenue, creating a pipeline of new patients to visit its hospitals and later to meet with doctors for testing and follow-up.

Mehrotra also said urgent care centers are not bound by the Emergency Medical Treatment and Work Act, a federal law. Known as Imtala Hospitals are required to stabilize patients regardless of their ability to pay.

At the time of Frankie’s visit, both the urgent care center and emergency room were owned by Floyd Health System, which operates a few hospitals and clinics in northwest Georgia and northeastern Alabama. Since then, Floyd integrated with atrial health A larger company headquartered in North Carolina that operates dozens of hospitals across the Southeast.

Frankie got a CT scan of her head and body in the emergency room, and tests by KHN confirmed that she was unable to make it to an urgent care center regardless of whether the test was medically necessary or just part of a protocol for people in car wrecks complaining of headaches. .

the decision: Sixteen months have passed since Frankie Cook’s visit to the hospital, and Russell has delayed paying any bills based on advice he got from a family friend who is a lawyer. After insurance covered his share, the cooks portion came to $1,042.

Getting to that number was a frustrating process, Russell said. He heard about the $1,705 proforma bill in a letter from a lawyer representing the hospital – another worrisome wrinkle of Frankie’s care as a result of the car crash. The cooks then had to go through a lengthy appeal process to remove a duplicate fee of $5,200 from the bill.

The insurer, Anthem Blue Cross Blue Shield, paid $4,006 of the claim. It said in a statement that it is “committed to providing access to high-quality medical care for our members. This matter has been reviewed in accordance with our clinical guidelines, and billed claims have been processed accordingly.”

“You’re not going to take us out on the street, but we have expenses like everyone else,” Russell said of the $1,042 credit.

“I would have loved a $200 urgent care visit, but that ship has set sail,” he added.

Takeaway: It is important to remember that urgent care centers are not subject to the same laws as emergency rooms and that they can be more selective about the people they treat. Sometimes their reasons are financial rather than clinical.

It’s not uncommon for urgent care centers – even those in large health systems – to turn away people who have been in car wrecks due to complications created by car insurance settlements.

Although urgent care visits are less expensive than going to the emergency room, clinics often cannot provide the same level of care. And you may have to pay for an urgent care visit only to find out that you need follow-up care in the emergency room. Then you could get stuck with two bills.

Bill of the month is a collective investigation by KHN And the NPR Explains and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and survey, KHN is one of the three major drivers in KFF (Caesar Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.

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