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Outrageous Walk-In 'ER' Clinic Bill

5,780 Views | 50 Replies | Last: 2 yr ago by Aggiewes
CaptnCarl
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10:16a, 2/25/21
AG
One evening in March I was feeling sick and short of breath, so I decided to go to a walk in clinic that was open. This clinic advertised as 'ER' services. After a flu test and a breathing treatment, I'm out the door in an hour.

Fast forward 8 month and I receive an invoice showing medium level emergency services. Of the $4200 bill, insurance paid $3500, leaving me with $700.

After I had gone there, I began hearing stories about this clinic, and some family friends of ours retained lawyers to help fight this clinic. Their Google reviews is littered with families being left with $9k, $5k, bills etc. It's extortion.

I want to fight these people because I feel terrible for the family whose finances would be wrecked by this type of encounter.

Comments, advice, lawyer plugs, etc are welcomed.
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Philip J Fry
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10:23a, 2/25/21
AG
It gets better. The insurance companies "negotiated" those rates. If you read the fine print in the agreement, you'll see that they are not allowed to charge cash paying customers LESS than that amount.
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CaptnCarl
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In reply to Philip J Fry • 10:43a, 2/25/21
AG
Thanks Phil. Insurance surely is one of the great joys of our time, and by joy I mean scam.
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RikkiTikkaTagem
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10:53a, 2/25/21
AG
Why do you call it a clinic l when it was clearly labeled as providing emergency services?


Outpatient care is labeled as
clinic like your pcp (cheapest)
Urgent care (medium)
Emergency (most expensive)

Emergency services are very expensive at any place hospital or stand alones. They have to be open 24 hours and see people regardless of ability to pay. They exist to to provide care to actively dying or patients needing immediate surgical or medical interventions. That's what you're paying for.
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CaptnCarl
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In reply to RikkiTikkaTagem • 11:16a, 2/25/21
AG
Does providing emergency services preclude a facility from providing clinical services?

You're getting to the heart of the issue that they're preying on people not knowing the difference in the services and not being transparent about pricing.

Would you say my symptoms of feeling sick and asthma classify as medium level emergency?
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aggie_wes
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11:21a, 2/25/21
AG
Where was it? I have a similar issue.

Went in for literally a covid test, they did nothing else. Charged my insurance 9k.
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RikkiTikkaTagem
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In reply to CaptnCarl • 11:37a, 2/25/21
AG
CaptnCarl said:
Does providing emergency services preclude a facility from providing clinical services?

You're getting to the heart of the issue that they're preying on people not knowing the difference in the services and not being transparent about pricing.

Would you say my symptoms of feeling sick and asthma classify as medium level emergency?


Yes, providing emergency services prohibits a facility from providing clinical services. That is a hard yes. That's why there's the label "emergency". They can't downgrade you and treat you as a "urgent" or "clinic" rate. They're not allowed to.

I'm letting you know if it says "emergency" on the building, you will always be charged that much.

With the symptoms question, it's an incomplete part of the clinical picture. Some sore throats are allergies some sore throats are peritonsillar abscesses that require immediate surgery. Some shortness of breath is just some mild bronchitis and some shortness of breath is pneumonia, pulmonary embolisms, heart attacks, CHF, pneumothorax or any other immediate life threatening pathology.

You, it seems unknowingly, self selected into the "it's an emergency category" so a place providing emergency services takes that seriously and rules out all of the life threatening issues with your complaint whether it be clinically based on your vitals, history and exam or with testing (labs and imaging).

I'm really am trying help educate people about what services to use because I don't want people to have unnecessary bills.

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RikkiTikkaTagem
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11:39a, 2/25/21
AG
Some places can be predatory and I wish those places would go out of business and be sued into oblivion but lots of the time it's a lack of communication, transparency about the services you're receiving and general knowledge about the health care system.
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Medaggie
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11:42a, 2/25/21
I am not here to defend high medical charges or place blame on who is responsible for high priced medical care but consumers do not understand how bills/charges work/insurance payment vs charges.

Bottom line is if you are going to an ER that is opened 24 hrs a day with a full staff including doctor/nurses/front desk/CT/Labs/meds then you are definitely paying to keep the lights on when there is no one in the ER. Sure your stand alone visit should not have been 5K and they surely made alot of $$$ from your visit it taken in isolation. But ER care/charges can not be taken when looking at each visit independently.

There are patients who will pay 10X what it cost for ER/medical care, some pay 1x, many do not pay at all.

Every industry would have high charges if they had to be open 24 hrs a day with full services.

Imagine a restaurant that was required to be opened 24hrs a day with a full menu and full wait staff. Your $20/meal would be $100 because very little happens between midnight and 10am.
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YouBet
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11:47a, 2/25/21
AG
So, with the proliferation of these stand-alone Emergency centers this is a known issue that's been in the news quite a bit. I can't fully speak to this other than some articles I read but you have to be careful which of these you go to.

Some are completely independent and may screw you and others are affiliated with hospitals. I believe the latter are the ones you want to go to if at all possible.
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Medaggie
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In reply to YouBet • 11:55a, 2/25/21
YouBet said:
So, with the proliferation of these stand-alone Emergency centers this is a known issue that's been in the news quite a bit. I can't fully speak to this other than some articles I read but you have to be careful which of these you go to.

Some are completely independent and may screw you and others are affiliated with hospitals. I believe the latter are the ones you want to go to if at all possible.
This is one of the biggest misconception there is. Being Stand alone vs hospital based have their own charge masters that are typically pegged to a multiple of medicare rates which are based on current Texas regulations.

I do ER medical billing reviews and chart reviews for insurance companies/lawyers and I can tell you that hospital based ER bills are typically more expensive and convoluted.

When you walk into a hospital based ER, get ready for

1. A hospital facility bill with about 20+ charge codes
2. A ER provider bill
3. A radiologist bill
4. A pathologist bill
5. A Trauma activation charge if injured

coming from 4-5 different billers with some being in network and some not.

I have seen Hospital ER bills for a car accident with a CT head, Chest Xray, some basic labs ranging from 15K on the low end to 50K+.


The reasons you see it on the news is b/c the insurance companies/lobbies generate most of these b/c they want everyone to go see their PCP so they can make a bigger profit.

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The Wonderer
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In reply to Medaggie • 12:20p, 2/25/21
AG
Medaggie said:
YouBet said:
So, with the proliferation of these stand-alone Emergency centers this is a known issue that's been in the news quite a bit. I can't fully speak to this other than some articles I read but you have to be careful which of these you go to.

Some are completely independent and may screw you and others are affiliated with hospitals. I believe the latter are the ones you want to go to if at all possible.
This is one of the biggest misconception there is. Being Stand alone vs hospital based have their own charge masters that are typically pegged to a multiple of medicare rates which are based on current Texas regulations.

I do ER medical billing reviews and chart reviews for insurance companies/lawyers and I can tell you that hospital based ER bills are typically more expensive and convoluted.

When you walk into a hospital based ER, get ready for

1. A hospital facility bill with about 20+ charge codes
2. A ER provider bill
3. A radiologist bill
4. A pathologist bill
5. A Trauma activation charge if injured

coming from 4-5 different billers with some being in network and some not.

I have seen Hospital ER bills for a car accident with a CT head, Chest Xray, some basic labs ranging from 15K on the low end to 50K+.


The reasons you see it on the news is b/c the insurance companies/lobbies generate most of these b/c they want everyone to go see their PCP so they can make a bigger profit.

Standing orders for LOP patients. Happens a lot at some smaller systems.
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YouBet
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In reply to Medaggie • 12:32p, 2/25/21
AG
Maybe I have it backwards then. I stand corrected.
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HalifaxAg
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12:48p, 2/25/21
AG
I feel like we all learn this lesson once in our lives...


It does seem predatory, but you learn to pay attention to the titles of those places real fast.

If only those places were required to tell you the minimum fees you can expect before services are rendered.
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Medaggie
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In reply to YouBet • 1:13p, 2/25/21
YouBet said:
Maybe I have it backwards then. I stand corrected.
I am not saying that all hospital based ERs are more expensive than Free Standing ones or visa versa.

What I am saying is you will getting many more charges and 3rd party bills when you go to a hospital based ER.

With many Free standing ER, not all, you typically get a bill for the facility&provider.

When you go to a hospital based ER, most docs/providers are contractors who do their own billing so you essentially will get 3-5 bills and have to deal with 3-5 billers to get any corrections done.

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YouBet
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In reply to Medaggie • 1:18p, 2/25/21
AG
Medaggie said:
YouBet said:
Maybe I have it backwards then. I stand corrected.
I am not saying that all hospital based ERs are more expensive than Free Standing ones or visa versa.

What I am saying is you will getting many more charges and 3rd party bills when you go to a hospital based ER.

With many Free standing ER, not all, you typically get a bill for the facility&provider.

When you go to a hospital based ER, most docs/providers are contractors who do their own billing so you essentially will get 3-5 bills and have to deal with 3-5 billers to get any corrections done.

I thought the issue I recall reading was more of a in-network vs out of network issue. IOW, the unaffiliated stand-alones are not as likely to be in your network and that's when people get hammered on the bill. But, maybe it was something else.
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CaptnCarl
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In reply to aggie_wes • 1:21p, 2/25/21
AG
West TX. Same clinic has a Location in Nacogdoches and Longview.

They're advertising covid testing on their website. I have a friend that was charged $7k for a covid test from them.
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Medaggie
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In reply to HalifaxAg • 1:22p, 2/25/21
HalifaxAg said:
If only those places were required to tell you the minimum fees you can expect before services are rendered.

This may sound logical but impossible to predict. How can any healthcare professional tell you what the minimum cost will be?

Even a plumber can't tell me how much it would cost to fix my frozen pipes. They tell me they think it will be around $300 but won't until they open up the walls.

Medicine is 100x more complicated. If you came in with Shortness of breath, there is no way a doctor can tell you what the costs will be.

It could be a simple bronchitis and script. It can be as complicated as a Blood clot requiring Labs/CXR/CT chest.

The only way to have transparent billing is to get rid of insurance companies. They are essentially the middle man who has created a convoluted system in order to maximize profits.


If you need an ACL repair, then the orthopedic surgeon should tell you it will costs $5K total and the insurance companies pay the 5K. So you can price shop and go to a surgeon that will charge 4K.

But currently, the surgeon has to send out a Bill for $20K in order for the insurance companies to delay payment/reject payment, add their discount, take 6 months to pay and then sends the surgeon $1000 which costs the surgeon $200 to work through the billing process.

I am well versed with billing and Free standing ERs. Some do well, but many are barely making it. There is a reason many Free standing ERs are closing down throughout the state and very few new ones opening up. These Freestanding ERs are not cash cows.
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Medaggie
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In reply to CaptnCarl • 1:30p, 2/25/21
CaptnCarl said:
West TX. Same clinic has a Location in Nacogdoches and Longview.

They're advertising covid testing on their website. I have a friend that was charged $7k for a covid test from them.
I hope you realize your friend's $7k charge is nothing close to what the insurance companies are paying. They would be bankrupt if they paid anything close to that.

If I sat down at a restaurant and the menu said $100 for a burger/fries, I would immediately leave. But if I jointed their free restaurant honors program, the same meal is $5, then that is what really matters.

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The Wonderer
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In reply to YouBet • 1:31p, 2/25/21
AG
YouBet said:
Medaggie said:
YouBet said:
Maybe I have it backwards then. I stand corrected.
I am not saying that all hospital based ERs are more expensive than Free Standing ones or visa versa.

What I am saying is you will getting many more charges and 3rd party bills when you go to a hospital based ER.

With many Free standing ER, not all, you typically get a bill for the facility&provider.

When you go to a hospital based ER, most docs/providers are contractors who do their own billing so you essentially will get 3-5 bills and have to deal with 3-5 billers to get any corrections done.

I thought the issue I recall reading was more of a in-network vs out of network issue. IOW, the unaffiliated stand-alones are not as likely to be in your network and that's when people get hammered on the bill. But, maybe it was something else.
Emergency services must be reimbursed at in-network rates regardless of network participation pursuant to ACA. Further, the facility and provider can seek additional reimbursement from the insurer and are not allowed to balance bill the patient under SB 1264.
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CaptnCarl
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In reply to Medaggie • 2:15p, 2/25/21
AG
Exactly, if they were transparent about their rates, people would leave.
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JSKolache
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2:23p, 2/25/21
AG
"Only" $700 - you are lucky. Many folks get hosed for thousands.
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YouBet
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In reply to The Wonderer • 3:32p, 2/25/21
AG
Maybe I'll just stay out of this conversation at this point.
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The Wonderer
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In reply to CaptnCarl • 3:33p, 2/25/21
AG
CaptnCarl said:
Exactly, if they were transparent about their rates, people would leave.
Reimbursement rates vary from health plan to health plan - the charges do not. To provide every possible rate is logistically impossible.
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The Wonderer
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In reply to YouBet • 3:35p, 2/25/21
AG
YouBet said:
Maybe I'll just stay out of this conversation at this point.
This is what I do for a living (SB1264 bill recovery). ER reimbursement has changed quite a bit in the last two-ish years in Texas.
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Duncan Idaho
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3:58p, 2/25/21
You went to an ER, you used ER services, you get an ER bill.

Always make sure if you are at an ER or and urgent care facility. The difference between the two is often as much as $1000s and as little as a few feet.

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HalifaxAg
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In reply to Medaggie • 4:48p, 2/25/21
AG
Medaggie said:
HalifaxAg said:
If only those places were required to tell you the minimum fees you can expect before services are rendered.

This may sound logical but impossible to predict. How can any healthcare professional tell you what the minimum cost will be?

Even a plumber can't tell me how much it would cost to fix my frozen pipes. They tell me they think it will be around $300 but won't until they open up the walls.

Medicine is 100x more complicated. If you came in with Shortness of breath, there is no way a doctor can tell you what the costs will be.

It could be a simple bronchitis and script. It can be as complicated as a Blood clot requiring Labs/CXR/CT chest.

The only way to have transparent billing is to get rid of insurance companies. They are essentially the middle man who has created a convoluted system in order to maximize profits.


If you need an ACL repair, then the orthopedic surgeon should tell you it will costs $5K total and the insurance companies pay the 5K. So you can price shop and go to a surgeon that will charge 4K.

But currently, the surgeon has to send out a Bill for $20K in order for the insurance companies to delay payment/reject payment, add their discount, take 6 months to pay and then sends the surgeon $1000 which costs the surgeon $200 to work through the billing process.

I am well versed with billing and Free standing ERs. Some do well, but many are barely making it. There is a reason many Free standing ERs are closing down throughout the state and very few new ones opening up. These Freestanding ERs are not cash cows.
Yes, but that's the problem exactly...the ER facilities don't charge based on severity. If you go to an ER facility, no way you're getting out for less than $500K (just kidding)...if someone shows up for a cold, write the script and charge accordingly. I'm sure there is plenty of dead time that could be filled with those types of patients.

If they setup shop to do both ER & urgent, triaged accordingly and directed non-emergent patients to their PA's and Nurse Practitioners and charged urgent rates for that while saving the ER doctor for emergency patients and charging ER rates for those cases, then it would be a win-win for everyone.



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Diggity
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In reply to HalifaxAg • 5:35p, 2/25/21
AG
or you just go to an urgent care clinic?
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Medaggie
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In reply to HalifaxAg • 7:12p, 2/25/21
This seems logical and simple but practically very difficult. The public would never put up with this. Lets put your example in play.

Image if you came in for a cough, get examined by the doc after vital signs are done and in his/her judgement do not feel it is emergent and should go to your PCP or UC. After spending 1-3 hrs in the "Triage", you are told go to the UC side. Will you be happy?

Image same example, and doc tells you to go to UC but it is closed

Image same example, you go to UC and decompensate/dies on the way b/c he happened to be wrong

SO who is going to pay the ER doc that just spent 10 min to examine you? It would take the ER doc another 5 minutes to give you a script but b/c its not emergent you get to go to an UC and wait another 2-3 hrs to get your script. How happy will you be?

You may not realize this but ALL ERs by law can do this. All an ERs are required to just do a screening exam and can tell you to go home to see your PCP b/c its not emergent. If this was actually put in practice there would be some very unhappy pts waiting 2 hrs to be told to go home and alot of law suits b/c there will be pts who will decompensate eventhough the doc did what was appropriate.

Bottom line is everyone has to make their decision in what they deem emergent. If you go to an ER, then you get an ER bill. If you go to a UC, you get a UC bill.

If I go to the Ritz, I get a Ritz bill so I have never gone to the Ritz b/c I am just as happy at a marriott.
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double aught
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7:22p, 2/25/21
AG
Yes, $700 out of pocket doesn't seem surprising for an emergency room. Similar to an ambulance. If you call one, they come immediately and have equipment and training to treat all sorts of stuff. If they transport you, they're not going to charge you a cut rate because the ailment was minor.
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bbr4132
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In reply to CaptnCarl • 8:03p, 2/25/21
I once got a bill from a walk in clinic for ~$1000 after insurance had already paid them $4000. I tore the bill up and threw it in the trash. That was probably 5 years ago and my credit has never been dinged, nor have any collection agencies tried contacting me.
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topher06
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In reply to CaptnCarl • 10:47a, 2/26/21
CaptnCarl said:
Does providing emergency services preclude a facility from providing clinical services?

You're getting to the heart of the issue that they're preying on people not knowing the difference in the services and not being transparent about pricing.

Would you say my symptoms of feeling sick and asthma classify as medium level emergency?


These "services" provided on every major intersection are absolutely predatory. There is a reason the locations have exploded over the past few years. There would be more outrage, but insurance bears most of the cost up front and the rapes your company is premiums on the back end. It's not sustainable.
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ramblin_ag02
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In reply to Medaggie • 12:14p, 2/26/21
AG
You're dead on about all this, though I have seen some private stand-alone ER's do a screening exam and send people away if they don't have insurance or don't pay up front.

Also, you can go to your PCP or urgent care, and if you are too sick for them they will send you to an ER. The reverse is not usually true. There are places that will triage obvious non-emergent cases to urgent care and clinic, but that's rare. You just never know with some of these complaints.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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water turkey
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12:40p, 2/26/21
I've always heard to go to Urgent Care Clinic instead of freestanding ER.
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CaptnCarl
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In reply to water turkey • 1:52p, 2/26/21
AG
I honestly did not realize there was a difference. I thought it was just a marketing ploy with wording.

A few months ago I got a nail through my hand. I didn't want to go to the hospital, but wanted it looked at ASAP. Went to an urgent care next to the hospital. I paid $175 upfront and that was then end of it.
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