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This guest blog is presented by Shara McClure, Divisional Senior Vice President of Texas Health Care Delivery for Blue Cross and Blue Shield of Texas.
Can you tell the difference between the facilities in the above photo?
You may have noticed a similar trend in your neighborhood. Suddenly, your local urgent care center neighborhood becomes a freestanding ER (FSER). While the word ‘emergency’ is added to the facility’s signage, it still has generally the same look and feel as the urgent care center did before. Can’t spot the difference? You’re not alone.
Many Texans learn they went to an FSER instead of an urgent care center only after receiving the bill—sometimes for thousands of dollars.
BCBSTX data shows FSERS look like urgent care centers and serve the same types of patients. Upper respiratory infections are the most common diagnoses for both urgent care centers and FSERs, but they make up a smaller part of the FSERs’ total caseload. Urgent care centers and FSERs also treat similar conditions. These include injuries, ear problems, skin infections and back problems, to name a few. FSERs do have more visits for more serious conditions like chest pain.
However, FSERs see many fewer patients per year than the urgent care centers at much higher costs per patient. This results in up to a ten-fold increase in total income for FSERs. Why is that? It’s mostly due to an increase in emergency department facility fees. These fees are typically charged by hospitals to cover the cost of caring for patients who are so sick or injured that they need emergency care. There is some debate about whether FSERs should be able to charge these fees for treating simple conditions.
And most important for your bottom line—the switch to FSERs results in about ten times the out-of-pocket costs for BCBSTX members. This financial burden can be especially hard on members who have a high-deductible health plan. This is because they may be responsible for part or all of the cost of their treatment. Many of the conditions mentioned above are not emergencies and can be treated in a much lower-cost health care setting like an urgent care center or at your primary care doctor’s office.
While our data comes from unique case studies from three facilities and cannot be generalized, there is evidence that some FSERs are increasing costs and reducing access to acute unscheduled care. FSERs tend to see patients for similar types of conditions as urgent care centers, just at higher prices.
What can you do to avoid paying a huge bill in a non-emergency situation? You have options. Visit smartercaretexas.com to learn about your choices and decide where to go based on your health care needs.
I was extremely surprised with a slightly different issue. I went to an ER that was actually a part of the hospital. BOTH the hospital and ER were listed as "in-network." BUT - the hospital had a contract with a physicians group to staff the ER. NONE of the physicians were in-network! So I received an ENORMOUS bill for doctor's care.
Fortunately, I contacted BCBSTX, explained the situation, and BCBS paid in-network. This was in January 2017. I complained (in writing) to the hospital, and they seemed to listen. But, I wonder what would have happened if I had a different insurance - one that wouldn't work to help me.
This type of system - where the facility is in-network, but the staff aren't, should NOT be allowed to exist. BCBS (and ALL other health insurance providers, including Medicare) should list the entire facility as out-of-network, if the doctor's the patient will see are not in-network!
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