#ERvisit #urgentcare #medicalbilling #healthinsurance
Hey there! Dealing with unexpected medical bills can be a hassle, especially when you thought you were going to an urgent care but ended up getting billed as an ER visit. Don’t panic though, there are steps you can take to try and resolve this situation. Let’s dive into some helpful tips and information to guide you through this confusing situation.
### Understanding the Difference Between Urgent Care and Emergency Room
First things first, it’s important to understand the distinction between an urgent care facility and an emergency room. While urgent care centers are designed to treat non-life-threatening conditions on a walk-in basis, emergency rooms are equipped to handle serious, life-threatening medical emergencies.
### The Issue with Being Billed as an ER Visit at an Urgent Care
When you went to the Dignity Health Urgent Care for a strep test, you expected to be treated as an urgent care patient. However, receiving a bill from a Regional Medical Center for an ER visit can be incredibly frustrating and confusing. Here are some common reasons why this may have happened:
– Coding error: Sometimes, medical billing codes can be incorrectly entered, leading to a mismatch between the services provided and how they are billed.
– Facility classification: In some cases, urgent care centers may be affiliated with larger hospitals, which could result in billing discrepancies.
### Steps to Take to Address the Billing Issue
If you find yourself in a similar situation where you’re being billed as an ER visit at an urgent care, here’s what you can do:
1. **Review Your Insurance Policy**: Take a close look at your insurance plan to understand what is covered and how different types of medical visits are categorized.
2. **Contact the Billing Department**: Reach out to the billing department of the Regional Medical Center to inquire about the billing discrepancy. Ask for a detailed breakdown of the charges and how the visit was classified as an ER visit.
3. **Appeal the Billing**: If you believe the bill was incorrectly coded, you have the right to appeal the charges. Provide any documentation or evidence to support your case.
4. **File a Complaint**: If you’re unable to resolve the issue with the billing department, consider filing a complaint with your state’s insurance department or healthcare regulatory agency.
5. **Seek Legal Advice**: In some cases, it may be necessary to seek legal advice if you feel that you’re being unfairly billed or if the situation is not being resolved through other means.
### Preventing Future Billing Issues
To avoid similar billing issues in the future, here are some proactive steps you can take:
– Verify the facility’s classification with your insurance provider before seeking treatment.
– Keep detailed records of all your medical visits, including the name of the facility and the services received.
– Review your medical bills carefully and question any discrepancies or unexpected charges.
### Final Thoughts
Dealing with a billing discrepancy like being billed as an ER visit at an urgent care can be frustrating, but with the right approach, you may be able to resolve the issue. Remember to stay proactive, advocate for yourself, and seek assistance if needed. Don’t hesitate to reach out to your insurance provider, the billing department, or regulatory agencies for help.
I hope these tips help you navigate this challenging situation. If you have any further questions or need additional guidance, feel free to reach out. Stay informed and empowered when it comes to your healthcare billing! 🩺💰🔍
Keywords: medical billing, urgent care, emergency room, insurance, billing discrepancy
I don’t know that the bill would be any different if you did go to an urgent care instead of an ER.
You owe it so pay it.
In the future, don’t go to an urgent care or ER for something that could have been handled by your general practice physician.
1. Tell the provider that you are appealing the charges. And ask that your file be tagged to prevent further collection efforts for a reasonable time.
2. File an appeal with your insurer. The bases for the appeal are (1) you have no paper that shows that you had a contract with Regional Medical Center and (2) it is a deceptive trade practice for an entity to hold itself out as an urgent care facility but to then charge as an emergency. (Health insurance policies in my area clearly state that the copay for urgent care is a specific dollar amount that is much lower than for an emergency room visit.)
3. Write to urgent care and the emergency room and request a copy of every piece of information in their files relating to your visit, your condition, and their request for reimbursement from Cigna. (You are particularly interested documents you signed when you came in and any facts relating to your move from urgent care to emergency care.)
4. Write your state Attorney General and lay out your claim that this is a deceptive trade practice. Send a copy of this claim to Cigna and to the urgent care place.
5. Write to your state insurance department and make the same claim. Also send a copy to Cigna and the Urgent Care.
I’d call the urgent care billing dept, they may have chosen the wrong billing codes. If this is the case, they can rebill.
If that doesn’t work, call insurance and explain situation. They may not be able to do anything though.
That exact thing happened to us years ago. Was called something like “Denver Urgent Care”.
They were actually like a satellite ER, and there were zero indications of this anywhere. We were pissed too. It didn’t cost us that much, but it was $200 more than we expected to pay.
A couple of months later they changed their name to ER Urgent Care. I guess someone threw a fit.
I’d expect this from Banner not so much Dignity but they’re all pretty corrupt I guess.
There’s a huge issue right now with pharmacy billing as Change Healthcare was a recent victim of a cyber attack.
Call their billing department and get it sorted. Probably nothing major, just the wrong code went to the clearing house.
Tell the insurance company to straighten it out or you’ll call your state’s division of insurance and banking.
You need to call the billing department for the place that billed you
I’ve encountered this before — our local children’s hospital has both urgent care and ER locations, but their “urgent care” visits get processed through insurance as an ER visit. Insurance has told me that the code they submit is “ambiguous” as to whether it’s ER or not.
When I call insurance to tell them it was urgent care, they will generally reprocess it (sometimes after being in contact with the hospital to verify that we were in the urgent care, not the ER) as an urgent care visit.
I have occasionally chosen not to argue when it wouldn’t make a difference in how much we pay, though.
Probably an actual ER l. I’ve seen this multiple times in the last 5ish years. Especially if it’s the same name as a local hospital but with Urgent Care behind it.
How do your insurance benefits differ between ER and urgent care charges? Do you need to pay a deductible on either or both? Was this an in network urgent care facility? Basically, what, exactly, did you expect to pay for this urgent care visit and how does that differ from what you are being asked to pay?
ETA: Hospital based urgent care facilities are often allowed to bill as ERs. If this was an in network facility, then the terms of that billing are dictated by CMS rules, the contract between Cigna and the hospital, and Cigna billing policies.
Regardless of that interface between the hospital and Cigna, if you visited an in network urgent care facility, then your individual health plan’s benefit structure will dictate your liability to the hospital. You need to refer to documents from Cigna that dictate your benefit structure. In particular, what should you owe after visiting a (presumably) in network urgent care facility? Is Cigna abiding by their promise to you? If not, appeal to Cigna. If so, then pay your bill.
For all the stuff insurance hassles people about, mis-billing is the one thing they really, really bring the hammer down on to the facility.
I had this happen to me, and it even got sent to COLLECTIONS by the ~~pizza-hut-and-taco-bell~~ urgent care/ER despite me contacting them and they saying they mis-billed. One phone call to my insurance and they sorted everything out instantly.
This is what I did, hope this helps:
1) Find the website of the exact facility you went to, get the URL and screenshots of them calling themselves “urgent care”
2) Look them up on google maps, take screenshots of them having “urgent care” in their name, if you use Street View and their sign says “urgent care” take screenshots of that too
3) Call up your insurance and get a human on the line who processes claims, tell them your story and that you came with receipts. If your insurance is worth their salt, they will either ask you for those or they will verify your proof themselves.
I followed up with the urgent care and the collections place just to double-confirm everything was sorted out.
Transparent, up-front billing was supposed to happen years ago, eliminating Russian Roulette surprise bills, but it never did.
This is awful, and has to end. Insurance companies are failing, they are doing everything in their power to not pay out claims. But you probably won’t hear about this on legacy news.
It all depends on something called “place of service” code. A lot of hospitals run freestanding ERs and urgent cares and bill them out as an ER visit. All depends on how the facility is registered with the insurance companies
Your insurance wouldn’t know if it was billed correctly or not. You need to talk to the provider who billed you about their codes.