Audra Melton for KHN
Frankie Cook remembers the car accident last year only in flashes.
She was driving a friend from high school down a winding road outside of Rome, Ga. She saw standing water from a recent rain. She tried to slow down but lost control of her car on a big bend. “The car rolled over three times,” Frankie said. “We turned around and started on the side of that hill. My car was on its side and the back end was crushed into a tree.”
Sounds bad, but Frankie says the airbags deployed and both passengers were wearing seat belts. So she only had a headache when her father, Russell Cook, came to pick her up from the crash site.
Frankie, then a high school student, was worried that she had a concussion that could affect her performance on an upcoming advanced level exam, so she and her father decided to stop by an urgent care center near their home. to have it examined. They did not go past the reception.
“‘We don’t carry liability insurance,'” says Russell, the receptionist at Atrium Health Floyd Emergency Care Rome told her, even though he wasn’t sure what she meant. “She told me, like, three times.”
The problem didn’t seem to be that the clinic lacked the medical expertise to assess Frankie, and the family had good health insurance. But, when injuries are the result of accidents, another insurer, such as auto or home, may be primarily responsible for medical expenses. Health insurance, if it’s on the hook at all, can kick in after the other insurer has paid.
The cooks appeared to be facing a reimbursement policy often used by urgent care centers to avoid waiting for car insurance settlement payments.
Russell was told to take Frankie to the ER, which by law must see all patients, regardless of those issues. The closest to Atrium Health Floyd Medical Centerwas about a mile down the road and belonged to the same hospital system as the urgent care center.
There, says Russell, a doctor examined Frankie “for just a few minutes,” did precautionary CT scans of her head and body, and sent her home with advice to “take Tylenol” and rest. . She did not have a concussion or serious head injury and was able to pass her AP exam on time.
Then the bill came.
The patient: Frankie Cook, 18, now a freshman in Rome, Ga.
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 an emergency room visit; it was later adjusted to $11,805 after a duplicate charge was removed.
Which give: The cooks encountered a danger in the healthcare system after Frankie’s car hit this tree: more and more hospital systems have urgent care centers, which have limits on who they treat – for financial and medical reasons.
Russell was quite upset after receiving such a large bill, especially when he tried to make a quick and inexpensive trip to the clinic. He said Frankie’s grandmother was seen at an urgent care center after a recent car accident and walked out with a bill of just a few hundred dollars.
“It’s kind of what I expected,” he said. “She just really needed to be checked out.”
So why was Frankie fired from an urgent care center?
Lou Ellen Horwitz, CEO of the Urgent Care Association, says it’s fairly common policy for urgent care centers not to treat injuries resulting from even minor car accidents. “Generally, as a general rule, they don’t deal with car accident victims, regardless of the extent of their injuries, because it’s going to go through this car insurance claims process before the provider is paid,” she said.
Horwitz says urgent care centers — even those in 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 says that “unfortunately” people tend to learn about these policies when they show up waiting for care.
Collapse the complicated relationship between health and car insurance companies and what do you have Barack Richmanprofessor of health policy at Duke University School of Law, calls “the extremely complex world we live in”.
“Each product has its own specifications of where to go and what it covers. Each is incredibly difficult and complex to administer,” he says. “And each imposes errors on the system.”
Atrium Health did not respond to repeated requests for comment on Frankie’s case.
Horwitz rejects the idea that a healthcare system could push people in car crashes from urgent care centers to emergency rooms for more money. Yet car insurance generally pays more than health insurance for the same services.
Richman remains skeptical.
“At the risk of sounding a little too cynical, there are always dollar signs when a health care provider sees a patient walk through the door,” Richman said.
Dr Ateev Mehrotra, a professor of health care policy at Harvard Medical School, says it was likely strategic for the urgent care center to be just down the street from the ER. Part of the strategy makes medical sense, he says, “because if a bad thing happens, you want to get them to a place with more skill very quickly.”
But he also says urgent care centers are “one of the most effective ways” for a health system to generate new revenue, creating a pipeline of new patients to visit its hospitals and see doctors later. for testing and monitoring.
Mehrotra also claims that urgent care centers are not bound by the Emergency Medical Treatment and Labor Act, a federal law. known as EMTALA which forces hospitals to stabilize patients regardless of their ability to pay.
At the time of Frankie’s visit, the urgent care center and emergency room were owned by Floyd Health System, which operated a handful of hospitals and clinics in northwest Georgia and northeastern Georgia. east of Alabama. Since then, Floyd has merged with Atrium Health — a larger North Carolina-based company that operates dozens of hospitals in the Southeast.
Frankie underwent a head and body CT scan in the ER, the tests which KHN confirmed she could not have made it to the urgent care center – whether the test was medically necessary or just part of of a protocol for people who are victims of car accidents and who complain of a headache.
Resolution: Sixteen months have passed since Frankie Cook’s hospital visit, and Russell has delayed paying the bill until the remaining uncertainties are resolved, on advice he received from a friend of the family who is a lawyer. After the insurance covered its share, the cooks’ share amounted to $1,042.
Reaching that number has been a frustrating process, says Russell. He heard about the initial bill of $17,005 in a letter from an attorney representing the hospital – another troubling finding of Frankie in a car accident. The cooks then had to go through a lengthy appeals process to get a duplicate charge of $5,200 removed from the bill.
Ultimately, Anthem Blue Cross Blue Shield, the Cooks’ health insurer, paid $4,006 of the claim. It said in a statement that it is “committed to providing access to high quality medical care for our members. This matter has been reviewed in accordance with our clinical guidelines and billed claims have been handled accordingly.”
“It’s not going to put us out on the street,” Russell says 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 sailed.”
Take-out: It is important to remember that urgent care centers are not governed by the same laws as emergency rooms and can be more selective about who they treat. Sometimes their reasons are financial and not clinical.
It is not uncommon for urgent care centers – even those in large health systems – to turn away people who have been involved in car accidents due to complications created by car insurance regulations.
Although emergency room visits are less expensive than emergency rooms, clinics often cannot provide the same level of care. And you may have to pay the cost of an urgent care visit just to find out you need follow-up care in the emergency room. Then you could be stuck with two bills.