Science

Turned away from urgent care—and toward a bigger ER bill

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

She was taking a friend home from high school on a winding road outside Rome, Georgia. He saw standing water from the recent rain. He tried to slow down but lost control of his car at a major turn. “The car almost flipped three times,” said Frankie. “We turned and drove off the side of this hill. My car was on his side, and the rear end was crushed in a tree.”

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

Frankie, who was a high school junior at the time, was worried that she might suffer an injury that might affect her performance on the upcoming advanced placement exam, so she and her father went to their house to check her out. Decided to stay at an urgent care center. They didn’t make it past the front desk.

Frankie Cook was driving a friend home from high school when his car ran off a winding country road outside Rome, Georgia, flipped several times, and hit a tree. Frankie was not badly hurt, but his family ran into another problem after he was turned away from the urgent care clinic for insurance reasons.

Russell Cook


“‘We don’t take third-party insurance,'” Russell said the receptionist at Atrium Health Floyd Urgent Care Rome told her, though she wasn’t sure what he meant. “He told me, like, three times.”

Urgent Care Clinics vs. ERS

The problem didn’t seem to be that the clinic lacked the medical expertise to evaluate Frankie. Instead, cooks were facing a reimbursement policy often used by urgent care centers to avoid waiting for payment from car insurance settlements.

Russell was told to take Frankie to an emergency room, where the law must see all patients regardless of such issues. Atrium Health was closest to Floyd Medical Center, about a mile down the road and owned by the same hospital system as the urgent care center.

There, Russell said, a doctor observed Frankie “for just a few minutes,” did a precautionary CT scan of his head and body, and sent him home with advice to “take some Tylenol” and rest. She didn’t have a head injury or serious injury and was able to take her AP exam on time.

Then came the bill.

Patient: 18-year-old Frankie Cook, now a first year college student from Rome, Georgia.

medical services: A 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; This was later adjusted to $11,805 after the duplicate charge was removed.

what gives: The cooks hit a menace in the health care system after Frankie’s car hit that tree: More and more hospital systems have urgent care centers that limit who they treat—for both financial and medical reasons.

cook-01.jpg
After Frankie Cook’s car wrecked on a wet road outside Rome, Georgia, his father, Russell (pictured above), received a letter from a lawyer saying that the high school student needed an emergency room visit. $17,000 to see if the high school student was hurt.

KHN. for Audra Melton


Russell was quite upset after receiving such a huge bill, especially as he tried to make a quick, cheap trip to the clinic. He said Frankie’s grandmother was seen in an urgent care center after a car wreck and walked out with a bill of a few hundred dollars.

“That’s what I was expecting,” he said. “He really needed to be seen.”

So why was Frankie turned away from the urgent care center?

It’s a pretty standard policy for urgent care centers to not treat injuries resulting from car accidents, even minor ones, said Lou Allen Horwitz, CEO of the Urgent Care Association. “Generally, as a rule, they don’t care for car accident victims regardless of the extent of their injuries, because it’s going to go through that auto insurance claims process before paying the provider,” she said. Told.

thin margin

Horwitz said urgent care centers — even those owned by large health systems — often operate on thin margins and can’t wait months and months for an auto insurance company to pay a claim. . She said that “unfortunately” people learn about such policies when they expect care.

Fold into the complex relationship between health and auto insurance companies and you have what Barack Richman, a professor of health care policy at Duke University’s Law School, called the “wildly complex world in which we live.”

“Each product has its own specifics about where to go and what’s involved. Administering each product is incredibly difficult and complicated,” he said. “And everyone imposes mistakes on the system.”

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

profit strategy?

Horwitz rejected the idea that a health system could push people in car wrecks from urgent care centers to emergency rooms to make more money off them. Still, auto insurance generally pays more than health insurance for similar services.

Richman remained skeptical.

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

Dr. Ativ Mehrotra, professor of health care policy at Harvard Medical School, said the prospect for an urgent care center to be right down the road from the ER was strategic. Part of the strategy makes sense medically, he said, “because if something bad happens, you want to get them to a location with more skill really quickly.”

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

Mehrotra also said that urgent care centers are not bound by the Emergency Medical Treatment and Labor Act, a federal law known as EMTALA, which allows hospitals to stabilize patients regardless of their ability to pay. is required to do.

At the time of Frankie’s visit, the urgent care center and emergency room were both owned by Floyd Health System, which operated a handful of hospitals and clinics in northwestern Georgia and northeastern Alabama. Since then, Floyd has merged with Atrium Health — a large, North Carolina-based company that operates dozens of hospitals throughout the Southeast.

Frankie underwent CT scans of her head and body in the emergency room, tests KHN confirmed she could not go to an urgent care center, even if the test was medically necessary or one for people in a car wreck who complained. be part of the protocol. of a headache.

resolution

Sixteen months have passed since Frankie Cook’s hospital visit, and Russell has delayed paying any bills, based on advice he received from a family friend, an attorney. After insurance covered his share, Cook’s share came to $1,042.

Reaching that number has been a frustrating process, Russell said. He heard about the initial $17,005 bill in a letter from a lawyer representing the hospital—another unnecessary wrinkle of Frankie’s care as a result of the car wreck. The cooks then had to follow a lengthy appeals process to remove the $5,200 duplicate fee from the bill.

Cook’s 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. The matter was reviewed in accordance with our clinical guidelines, and Bill’s claims were processed accordingly.” it was done.”

“It’s not going to hit us down the road, but we’ve got expenses like everyone else,” Russell said of the $1,042 balance.

“I’d love a $200 urgent care trip, but that ship has sailed,” he said.

KHN (Kaiser Health News) is a national newsroom that conducts in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three major operational programs of the KFF (Kaiser Family Foundation). KFF is a thriving non-profit organization that provides information on health issues to the nation.

Related Articles

Leave a Reply

Your email address will not be published. Required fields are marked *

Back to top button