Turned Away From Urgent Care — And Toward a Big ER Bill

Frankie Cook dinner remembers final yr’s automobile crash solely in flashes.

She was driving a buddy residence from highschool on a winding street outdoors Rome, Georgia. She noticed standing water from a latest rain. She tried to decelerate however misplaced management of her automobile on a giant curve. “The automobile flipped about 3 times,” Frankie stated. “We spun round and went off the aspect of this hill. My automobile was on its aspect, and the again finish was crushed up right into a tree.”

Frankie stated the air luggage deployed and each passengers have been sporting seat belts, so she was left with only a headache when her father, Russell Cook dinner, got here to choose her up from the crash web site.

Frankie, then a highschool junior, anxious she may need a concussion that would have an effect on her efficiency on an upcoming Superior Placement examination, so she and her father determined to cease by an pressing care middle close to their home to get her checked out. They didn’t make it previous the entrance desk.

Frankie Cook dinner was driving a buddy residence from highschool when her automobile ran off a winding nation street outdoors Rome, Georgia, flipped a number of instances, and hit a tree. She wasn’t badly damage, however her household shortly bumped into one other downside after she was turned away from an pressing care middle for insurance coverage causes.(Russell Cook dinner)

“‘We don’t take third-party insurance coverage,’” Russell stated the receptionist at Atrium Well being Floyd Pressing Care Rome advised him, although he wasn’t positive what she meant. “She advised me, like, 3 times.”

The issue didn’t appear to be that the clinic lacked the medical experience to judge Frankie. Fairly, the Cooks gave the impression to be confronting a reimbursement coverage that’s typically utilized by pressing care facilities to keep away from ready for funds from automobile insurance coverage settlements.

Russell was advised to take Frankie to an emergency room, which by legislation should see all sufferers no matter such points. The closest one, at Atrium Well being Floyd Medical Heart, was a couple of mile down the street and was owned by the identical hospital system because the pressing care middle.

There, Russell stated, a physician appeared Frankie over “for only a few minutes,” did precautionary CT scans of her head and physique, and despatched her residence with recommendation to “take some Tylenol” and relaxation. She didn’t have a concussion or severe head harm and was capable of take her AP examination on time.

Then the invoice got here.

The Affected person: Frankie Cook dinner, 18, now a first-year school scholar from Rome, Georgia.

Medical Providers: A medical analysis and two CT scans.

Service Supplier: Atrium Well being Floyd, a hospital system with pressing care facilities in northwestern Georgia and northeastern Alabama.

Whole Invoice: $17,005 for an emergency room go to; it was later adjusted to $11,805 after a replica cost was eliminated.

What Provides: The Cooks hit a hazard within the well being care system after Frankie’s automobile struck that tree: An increasing number of hospital programs personal pressing care facilities, which have limits on who they deal with — for each monetary and medical causes.

Russell was fairly upset after he obtained such a big invoice, particularly when he had tried to make a fast, cheap journey to the clinic. He stated Frankie’s grandmother was seen at an pressing care middle after a automobile wreck and walked out with a invoice for only a few hundred {dollars}.

“That’s sort of what I used to be anticipating,” he stated. “She simply actually wanted to be appeared over.”

So why was Frankie turned away from an pressing care middle?

Lou Ellen Horwitz, CEO of the Pressing Care Affiliation, stated it’s a fairly commonplace coverage for pressing care facilities to not deal with accidents that end result from automobile crashes, even minor ones. “Typically, as a rule, they don’t deal with automobile accident victims whatever the extent of their accidents, as a result of it will undergo that auto insurance coverage claims course of earlier than the supplier will get paid,” she stated.

Horwitz stated pressing care facilities — even ones owned by huge well being programs — typically function on skinny margins and might’t wait months and months for an auto insurance coverage firm to pay out a declare. She stated “sadly” folks are likely to study such insurance policies once they present up anticipating care.

Fold within the difficult relationship between well being and auto insurance coverage firms and you’ve got what Barak Richman, a well being care coverage professor at Duke College’s legislation faculty, referred to as “the wildly advanced world that we stay in.”

“Every product has its personal specs about the place to go and what it covers. Every one is extremely tough and sophisticated to manage,” he stated. “And each imposes errors on the system.”

Atrium Well being didn’t reply to repeated requests for touch upon Frankie’s case.

A photo shows Frankie Cook conversing with her dad in the kitchen.
After Frankie Cook dinner’s automobile wreck on a moist street outdoors Rome, Georgia, her father, Russell, obtained a lawyer’s letter saying they owed $17,000 for an emergency room go to to see whether or not Frankie had gotten a concussion.(Audra Melton for KHN)

Horwitz dismissed the concept a well being system would possibly push folks in automobile wrecks from pressing care facilities to emergency rooms to earn more money off them. Nonetheless, auto insurance coverage typically pays greater than medical health insurance for a similar companies.

Richman remained skeptical.

“On the threat of sounding a little bit too cynical, there are all the time greenback indicators when a well being care supplier sees a affected person come via the door,” Richman stated.

Dr. Ateev Mehrotra, a professor of well being care coverage at Harvard Medical College, stated it was possible strategic for the pressing care middle to be proper down the road from the ER. A part of the technique is smart medically, he stated, “as a result of if a foul factor occurs, you need to get them to some place with extra talent actually shortly.”

However he additionally stated pressing care facilities are “one of the vital efficient methods” for a well being system to generate new income, making a pipeline of latest sufferers to go to its hospitals and later see medical doctors for testing and follow-up.

Mehrotra additionally stated pressing care facilities will not be certain by the Emergency Medical Remedy and Labor Act, a federal legislation often known as EMTALA that requires hospitals to stabilize sufferers no matter their potential to pay.

On the time of Frankie’s go to, each the pressing care middle and emergency room have been owned by Floyd well being system, which operated a handful of hospitals and clinics in northwestern Georgia and northeastern Alabama. Since then, Floyd has merged with Atrium Well being — a bigger, North Carolina-based firm that operates dozens of hospitals throughout the Southeast.

Frankie obtained a CT scan of her head and physique within the emergency room, checks KHN confirmed she couldn’t have gotten on the pressing care middle no matter whether or not the check was medically vital or simply a part of a protocol for folks in automobile wrecks who complain of a headache.

A photo shows Frankie and Russell Cook sitting on a sofa together, looking at the camera.
(Audra Melton for KHN)

Decision: Sixteen months have handed since Frankie Cook dinner’s hospital go to, and Russell has delayed paying any of the invoice on recommendation he obtained from a household buddy who’s an lawyer. After insurance coverage coated its share, the Cooks’ portion got here to $1,042.

Attending to that quantity has been a irritating course of, Russell stated. He heard concerning the preliminary $17,005 invoice in a letter from a lawyer representing the hospital — one other unnerving wrinkle of Frankie’s care ensuing from the automobile wreck. The Cooks then needed to pursue a prolonged attraction course of to get a $5,200 duplicate cost faraway from the invoice.

Anthem Blue Cross Blue Protect, the Cooks’ insurer, paid $4,006 of the declare. It stated in a press release that it’s “dedicated to offering entry to high-quality medical take care of our members. This matter was reviewed in accordance with our medical tips, and the billed claims have been processed accordingly.”

“It’s not going to place us out on the road,” Russell stated of the $1,042 stability, “however we’ve obtained bills like everyone else.”

He added, “I might have cherished a $200 pressing care go to, however that ship has sailed.”

The Takeaway: It’s essential to keep in mind that pressing care facilities aren’t ruled by the identical legal guidelines as emergency rooms and that they are often extra selective about who they deal with. Generally their causes are monetary, not medical.

It’s not unusual for pressing care facilities — even ones in giant well being programs — to show away individuals who have been in automobile wrecks due to the problems that automobile insurance coverage settlements create.

Though pressing care visits are cheaper than going to an emergency room, the clinics typically can’t provide the identical stage of care. And also you may need to pay the price of an pressing care go to simply to search out out you want follow-up care within the emergency room. Then you would be caught with two payments.

Invoice of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical payments. Do you may have an attention-grabbing medical invoice you need to share with us? Inform us about it!

This story was produced by KHN (Kaiser Well being Information), a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is among the three main working applications at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering info on well being points to the nation.

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