We’ve all had the experience — you, or a loved one, gets sick or injured and needs medical attention outside of a scheduled doctor’s visit, so you go to an urgent care center — or what you think is an urgent care center — for help.
You may be in for a surprise if you pull into one of many free-standing emergency rooms that are popping up in affluent areas around our city. At first glance, they look very much like the urgent care centers we have all come to depend on, but the similarities stop there. A “normal” emergency room is at a hospital. Freestanding emergency rooms are at facilities that are in strip malls and other smaller, freestanding buildings. They're like "minute-clinics" but charge hospital emergency room prices.
Since a 2010 licensing law took effect in Texas, for-profit, free-standing ERs have rapidly expanded across the state and around San Antonio. These free-standing ERs are typically equipped to address medical emergencies and often represent a level of care far exceeding the medical needs of a patient with urgent issues, such as a cut that needs stitches, a sprained ankle, the flu or an ear infection.
While a traditional urgent care clinic would refer a patient to an emergency room for complicated care or a life- or limb-threatening condition, a free-standing emergency room is not required to refer a patient to an urgent care facility for the flu.
What impact does this have on patients? In short, significant out-of-pocket costs. In most cases, free-standing ERs may not contract with your insurance company, leaving you vulnerable to “surprise bills” that far exceed the cost of seeking care at your doctor’s office or an urgent care center. This is called “balance billing.”
They may say they take your insurance but omit that this will likely be considered an “out-of-network” benefit.
Remember: Where you go matters.When possible, I urge people to seek care in the most appropriate setting for the type of treatment needed. In a true medical emergency, seek immediate care in the nearest emergency facility. When your care is simply urgent, take stock of your options; consider calling your doctor first for advice (even after hours and weekends) and then your insurance carrier for guidance locating a convenient in-network urgent care center and other services.
Education is key. As an empowered patient and smart health care consumer, ask questions until you get the answers you need to manage your medical concerns without mismanaging your pocketbook. There are tools and resources available to help you make informed decisions. Blue Cross and Blue Shield of Texas, for example, offers a variety of patient education tools, including a smartphone app for finding the nearest urgent care clinic, and a 24-hour nurse line to help you rein in potential higher costs at free-standing ER centers.
We are in this together. Controlling health care costs for individuals and for our state is a complex matter that requires the combined effort of the government, insurers, hospitals, physicians and informed patients.
Even small steps can help. By providing patients a written notice at the time of service, health care providers can educate them on billing practices, network participation and price ranges for commonly billed services. When patients have access to information about pricing and network participation, they can both improve their health and protect themselves from unnecessary health care costs.
As the health care system continues to go through significant changes, it’s important for patients to have options that help them better understand health care decisions — for themselves and their families.
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