Surprise! That Urgent Care Center May Send You A Big Bill
“Do you take my health insurance?” This is the first question people have when calling an urgent care. Despite a ‘Yes’, people are receiving huge bills–sometimes hundreds or thousands of dollars more than their “copay”. All of this confusion, red tape and bureaucracy is the reason that Evolve Medical has opted to make pricing 100% transparent. Urgent care visits are $85 and member visits are $25. Insurance almost always reimburses those fees because they are reasonable and there is no “balance billing” of hundreds of dollars. An important article published today in both CNN and Kaiser Health News explain why so many people are being balanced billed.
Sallyann Johnson considers herself a pretty savvy health care consumer. When she fell and injured her hands and wrists, she didn’t head for an expensive emergency room, choosing an urgent care clinic instead.
Before seeking treatment, she asked the key question: Did the center accept her insurance? Yes, Johnson was assured, both on the phone and then again when she arrived at the clinic.
After X-rays and a visit with a physician assistant, Johnson learned her wrists were sprained, but weeks later, it was her wallet that sustained the most damage.
“I received a bill from a doctor for $356,” said Johnson, 62. “I felt I asked all the right questions. I even re-asked the
Earlier this month, the New York State attorney general wrote businesses that operate dozens of urgent care clinic locations, saying the health plan participation information on their websites may be “deceptive” and asking for specific information about which insurance plans they participate in as in-network partners.
In New York and nationally, insurance coverage information provided on urgent care clinic websites is often unclear. Some centers’ websites say they “accept most major insurance plans” while others list specific insurers they “accept,” or “work with” or “bill.” But what does that mean?
Accepting insurance might mean a consumer will owe the balance between what the clinic charges and what an insurer pays toward an out-of-network visit, which is generally far less than payment for an in-network provider.
Such statements “may lead consumers to believe that an out-of-network urgent care center is … ‘in network’ with their health plan,” say the July 2 letters from N.Y. Attorney General Eric T. Schneiderman.
The centers may well be in-network with some insurers. But if they’re not, “consumers may receive unexpected, and often costly, bills … when they believed that they would be responsible solely for their copayment …,” the letters say.
Another interesting story. This one is from The Washington Post: “This $153,000 rattlesnake bite is everything wrong with American health care.” Published July 20, 2015.
Surprise bills, also known as “balance bills,” are part of the complex way that health care is paid for in the U.S. Insurers form networks as one way to slow rising health care costs, in part by getting doctors and hospitals who join to agree to negotiated rates, which are generally lower than their usual fees. Out-of-network hospitals and doctors can set their own fees and “balance bill” patients for the portion insurers don’t cover.
As insurers shrink networks, some patients may be unable to find an in-network provider. And others may get a balance bill after choosing an in-network hospital, only to learn later that the anesthesiologist or the lab were not included in their insurer’s network. Balance bills can run into thousands of dollars.
The key question to ask when calling an urgent care center, Hutson said, is not whether it accepts your insurance, but whether it participates in your insurance plan.
Even then, as Sallyanne Johnson learned, you might still get billed. In her case, the urgent care center was in network. But the doctor group overseeing the care was not. Hence the $356 bill, which Johnson paid. Even her insurer was surprised, she said.