Sunday, January 19, 2020

A Small Matter Of A Big Bill

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It’s no surprise that people are trying to save money on their health care costs. What could be a surprise is the bill you receive from an urgent care clinic. If you’re like me, then you normally consider these clinics to be cheaper than going to a hospital’s emergency room. However, that may not be the case.


Consider a woman who injured her hands and wrists. Rather than going to a hospital for X-rays, she went to an urgent care center where she believed her bill would be lower. In a Kaiser Health News article titled, Surprise! That Urgent Care Center May Send You A Big Bill (Just Like The ER), this woman even did her due diligence before receiving treatment and confirmed that the center accepted her insurance.


So with that knowledge, she confidently went to the clinic, got X-rayed, and consulted with a physician assistant. Luckily, it was just a sprain, but the shock came when the bill for services arrived. While she was correct in assuming that urgent care centers are typically less expensive than hospitals, that’s only the case if they are part of the patient’s insurance network and consumers need to specifically ask about this and not just whether their insurance is accepted.


Most urgent care websites list that they accept most major insurance plans, or that they accept, work with, or bill an insurer. But while a consumer may think that it means the center is in their network, that’s not the case at all and they will be billed at the out-of-network rate and pay the balance of what their insurance won’t cover.


What’s even more confusing, and worse for the consumer, is that a clinic may be in-network, but the doctor or lab may not be. Such was the case of the woman with the sprained wrist because all the doctors were subcontracted.


As health care consumers, the best we can do for now is ask whether a facility and any professional who sees us participates in our insurance plan and is in-network. Unfortunately, during an emergency this may be impossible or improbable.

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