HomeHealthWalked away from urgent care and faced a huge ER bill

Walked away from urgent care and faced a huge ER bill


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

He was driving to a friend’s house from high school down a winding road outside of Rome, Georgia. He saw standing water from a recent rain. He tried to slow down but lost control of his car on a big curve. “The car flipped about three times,” Frankie said. “We turned around and went down the side of this hill. My car was on its side, and the rear end was smashed into a tree.”

Frankie said the airbags deployed and both passengers were wearing seat belts, leaving her with nothing but a headache when her father, Russell Cook, came to pick her up at the crash site.

Frankie, then a high school junior, was concerned that she might have a concussion that could affect her performance on an upcoming Advanced Placement exam, so she and her father decided to stop by an urgent care center near your home for inspection. They didn’t get past the reception.

Frankie Cook was driving a friend home from high school when her car skidded off a winding country road outside Rome, Georgia, flipped several times and hit a tree. Frankie was not seriously injured, but her family quickly found itself with another problem after she was turned away from an urgent care clinic for insurance reasons.

russell cook


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

Urgent care clinics versus emergency rooms

The problem didn’t seem to be that the clinic lacked the medical expertise to evaluate Frankie. Rather, the Cooks seemed to be dealing with a reimbursement policy often used by urgent care centers to avoid waiting for car insurance settlement payments.

Russell was told to take Frankie to an emergency room, which by law must treat all patients regardless of such problems. The closest in Atrium Health Floyd Medical Centerit was about a mile down the road and owned by the same hospital system as the urgent care center.

There, Russell said, a doctor examined Frankie “for a few minutes,” took precautionary CT scans of her head and body, and sent her home with the advice to “take some Tylenol” and rest. She did not suffer a concussion or serious head injury and she was able to take her AP exam on time.

Then the bill came.

The patient: Frankie Cook, 18, now a college freshman 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 Northwest Georgia and Northeast Alabama.

Total count: $17,005 for an emergency room visit; later adjusted to $11,805 after a duplicate charge was dropped.

What gives: The Cooks faced a peril in the health care system after Frankie’s car hit that tree: More and more hospital systems have urgent care centers, which have limits on who they treat, both for financial and nonfinancial reasons. medical.

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After Frankie Cook’s car accident on a wet road outside of Rome, Georgia, his father, Russell (pictured above), received a letter from a lawyer saying they owed $17,000 for an emergency room visit to see if the high school student had suffered a concussion.

Audra Melton for KHN


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

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

So why was Frankie turned away at an urgent care center?

Lou Ellen Horwitz, executive director of the Urgent Care Association, said it’s fairly standard policy for urgent care centers not to treat injuries resulting from car accidents, even minor ones. “They usually, as a general rule, don’t treat car accident victims, regardless of the extent of their injuries, because they’re going to go through that auto insurance claims process before the provider gets paid,” she said.

fine margins

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 “sadly” people tend to find out about such policies when they show up expecting attention.

fold in the complicated relationship between auto and health insurance companies and you have what barak richmanprofessor of health care policy at Duke University Law School, called “the tremendously complex world we live in.”

“Each product has its own specifications on where to go and what it covers. Each one is incredibly difficult and complex to manage,” he said. “And each imposes bugs on the system.”

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

Profit strategy?

Horwitz dismissed the idea that a health system could take people in car accidents from urgent care centers to emergency rooms to make more money from them. Still, auto insurance typically pays more than health insurance for the same services.

Richman remained skeptical.

“At the risk of sounding overly cynical, there are always dollar signs when a health care provider sees a patient walk in the door,” Richman said.

Dr. Ateev Mehrotra, a professor of health care policy at Harvard Medical School, said it was probably strategic that the urgent care center was just down the street from the emergency room. Part of the strategy makes medical sense, he said, “because if something bad happens, you want to get them somewhere with more skill really fast.”

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

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

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

Frankie had a head and body CT scan in the emergency room, tests that KHN confirmed she could not have received at the urgent care center, regardless of whether the test was medically necessary or just part of a protocol to people in car accidents who complain. of a headache

Resolution

Sixteen months have passed since Frankie Cook’s hospital visit, and Russell has fallen behind on the bill due to advice he received from a family friend who is a lawyer. After insurance covered his share, the Cooks’ share came to $1,042.

Getting to that number has been a frustrating process, Russell said. He learned of the initial $17,005 bill in a letter from an attorney representing the hospital—another puzzling wrinkle in Frankie’s care as a result of the car accident. The Cooks then had to go through a lengthy appeals process to have a $5,200 duplicate charge removed from the bill.

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

“It’s not going to put us out on the street,” Russell said of the $1,042 balance, “but we have expenses like everyone else.”

He added, “I would have loved a $200 urgent care visit, but that ship has sailed.”

khn (Kaiser Health News) is a national newsroom that produces detailed journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the top three operating programs in KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.



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