Moved away from urgent care — and toward a big ER bill

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

He was driving a friend home from high school on a winding road outside Rome, Georgia. He saw standing water from recent rains. He tried to slow down but lost control of his car on a big curve. “The car overturned about three times,” Frankie said. “We turned around and drove past this mountain. My car was on its side, and the rear end was crushed against a tree.”

Frankie said the air bags deployed and both passengers were wearing seat belts, so she had a headache when her father, Russell Cook, came to pick her up from the crash site.

Frankie, then a high school junior, was concerned that he might have an injury that could affect his performance on an upcoming Advanced Placement exam, so he and his father decided to stop at an urgent care center near their home to check him out. They didn’t get past the front desk.

Frankie Cook was driving a friend home from high school when his car ran off a winding country road outside Rome, Georgia, overturned multiple times and hit a tree. He wasn’t badly injured, but his family quickly ran into other problems after being turned away from an urgent care center because of insurance.(Russell Cook)

“‘We don’t accept third-party insurance,'” Russell said the receptionist at the Atrium Health Floyd Urgent Care room told him, though he wasn’t sure what she meant. “He told me, like, three times.”

The problem does not seem to be that the clinic lacked the medical expertise to evaluate Frankie. Rather, Cooks appears to be countering a reimbursement policy often used by urgent care centers to avoid waiting for payments from car insurance settlements.

Russell was told to take Frankie to an emergency room, where the law requires all patients to be seen regardless of such problems. The closest, Atrium Health at Floyd Medical Center, was about a mile down the road and owned by the same hospital system as the urgent care center.

There, Russell said, a doctor saw Frankie “for just a few minutes,” performed a precautionary CT scan of his head and body, and sent him home with advice to “take some Tylenol” and rest. He had no head injuries or serious injuries and was able to take his AP exam on time.

Then came the bill.

Patient: Frankie Cook, 18, is now a first-year college student in 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 Bill: $17,005 for emergency room visits; This was adjusted to $11,805 after removing a duplicate charge.

Last hour: After Frankie’s car hits that tree, Cook poses a setback to the health care system: More and more hospital systems own urgent care centers, which have limits on who they treat — both for financial and medical reasons.

Russell was quite annoyed after receiving such a large bill, especially when he tried to get to the clinic quickly, cheaply. He said Frankie’s grandmother was seen at an urgent care center after a car wreck and walked out with just a few hundred dollars in bills.

“This is kind of what I was hoping for,” he said. “He really needed to be seen.”

So why did Frankie move away from an urgent care center?

Lou Ellen Horvitz, CEO of the Urgent Care Association, says it’s pretty standard policy for urgent care centers not to treat injuries resulting from car accidents, even minor ones. “Typically, as a rule, they don’t take care of car accident victims, regardless of the extent of their injuries, because it’s going to go through that auto insurance claim process before the payer gets paid,” he said.

Horwitz says urgent care centers — even those owned by large health systems — often operate on thin margins and can’t wait months for an auto insurance company to pay a claim. “Unfortunately,” she said, people learn about such policies when they show up expecting care.

Fold in the complicated relationship between health and auto insurance companies, and you have “the wildly complicated world we live in,” says Barack Richman, professor of health care policy at Duke University Law School.

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

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

One photo shows Frankie Cook talking to her father in the kitchen
After Frankie Cook’s car wrecks on a wet road outside Rome, Georgia, her father, Russell, receives a letter from a lawyer saying they owe Frankie $17,000 for an emergency room visit to see if he’s injured.(Audra Melton for KHN)

Horwitz rejects the idea that a health system can push people from car wrecks to urgent care centers to emergency rooms in order to make more money off of them. Still, auto insurance typically pays more than health insurance for the same service.

Richman remained skeptical.

“At the risk of sounding a little too sarcastic, there’s always a dollar sign when a health care provider sees a patient coming through the door,” Richman says.

Dr. Ativ Mehrotra, a professor of health care policy at Harvard Medical School, said it’s probably strategic for an urgent care center to be down the street from the ER. Part of the strategy makes medical sense, he said, “because if a bad thing happens, you want to move them to some place more efficiently more quickly.”

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

Mehrotra also said urgent care centers are not bound by the Emergency Medical Treatment and Labor Act, a federal law known as EMTALA that 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 several 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 across the Southeast.

Frankie received a CT scan of her head and body in the emergency room, tests KHN confirmed did not go to an urgent care center regardless of whether the test was medically necessary or part of a protocol for those who report car wrecks. headache

One picture shows Frankie and Russell Cooke sitting together on a sofa looking at the camera.
(Audra Melton for KHN)

Resolution: Sixteen months have passed since Frankie Cook’s hospital visit, and Russell, an attorney, has delayed paying the bill on advice from a family friend. After insurance covered his share, Cook’s share came to $1,042.

Reaching these numbers is a frustrating process, Russell said. He heard about the initial $17,005 bill in a letter from a lawyer representing the hospital—another uncomfortable wrinkle in Frankie’s care from the car wreck. The Cooks then had to follow a lengthy appeals process to remove the $5,200 duplicate charge from the bill.

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

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

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

Takeaway: It’s important to remember that urgent care centers are not governed by the same laws as emergency rooms, and they can be more selective about who they treat. Sometimes their reasons are financial, not clinical.

It’s not uncommon for urgent care centers — even among large health systems — to turn people away in car wrecks because of the complications that arise from car insurance settlements.

Although urgent care visits are less expensive than emergency room visits, clinics often cannot provide the same level of care. And you may have to pay for an urgent care visit only to find out you need follow-up care in the emergency room. Then you could be stuck with two bills.

Bill of the Month by a crowdsourced investigation KHN And NPR which dissects and explains medical bills. Have an interesting medical bill you want to share with us? Tell us about it!

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