JUANA SUMMERS, HOST:

It’s time now for our Medical Bill of the Month. And Dr. Elisabeth Rosenthal is editor-in-chief of our partner Kaiser Health News and is with us to talk about urgent care, emergency care and how those two sites of treatment interact. Dr. Rosenthal, welcome back.

ELISABETH ROSENTHAL: Thanks. It’s good to be here.

SUMMERS: So tell us. Who are we meeting today?

ROSENTHAL: Today we meet the Cook family of Rome, Ga. The dad is Russell Cook, and his daughter is Frankie, who’s a college freshman now. After Frankie was in a car accident, they found out that one huge difference between urgent care and emergency room care is the size of the bill. And that’s true for the same patient and the same patient complaint.

SUMMERS: Oh, gosh. This does not sound good. KHN reporter Sam Whitehead visited the Cooks. Let’s listen to their story.

SAM WHITEHEAD: Frankie Cook remembers last year’s car accident in flashes. She was driving a friend home from high school on a winding country road. She saw standing water and tried to slow down but hydroplaned.

FRANKIE COOK: The car flipped about three times. We spun around and went off the side of this hill. And so my car was on its side, and, like, the back end was crushed up into a tree.

WHITEHEAD: Frankie and her friend were wearing seatbelts when the car’s airbags deployed, so nobody was seriously hurt when the police and Frankie’s dad Russell got there.

RUSSELL COOK: All of the adults were kind of amazed that they were OK.

WHITEHEAD: But it looked bad enough.

R COOK: Oh, it looked terrifying. Yeah. They were lucky to have just walked away.

WHITEHEAD: Frankie was fine except for a bit of a headache and a worry she just couldn’t shake.

F COOK: I just was concerned, because of the nature of the wreck, that I had a concussion of some sort. And I had an AP exam two days later, my AP physics exam. And so I was like, I don’t want to, you know, take that with a concussion.

WHITEHEAD: So the Cooks went to an urgent care clinic. Russell told a receptionist there that Frankie had been in a car accident and he’d like to have her checked out.

F COOK: And they said, oh, we don’t take third-party insurance. And it made no sense to me. And she told me, like, three times, we don’t take third-party insurance. You have to go to the hospital for that.

WHITEHEAD: The nearest ER was about a mile down the road and owned by the same company as the urgent care.

F COOK: They’re all pretty close together. It’s so much easier to just go to the one that’s right there, that’s owned by the same people.

WHITEHEAD: Two CT scans came back clear – no concussion or other internal injuries. And Frankie was sent home with instructions to take it easy for a few days. She passed her AP exam, by the way. So Russell was shocked when he got a letter from the hospital’s lawyer saying it was $17,000 for the ER visit.

R COOK: I was pissed, I mean, really, you know, kind of up in arms. Why did I get a $17,000 bill?

WHITEHEAD: Russell pushed the hospital for a breakdown of the bill. There was a duplicate $5,000 trauma assessment fee, and Frankie was billed for a Level IV ER visit, the second highest level of severity.

R COOK: She walked in and walked out and was told to take some Tylenol, you know? So I just wanted to know why was she billed as that because I’ve got to pay for it.

WHITEHEAD: Russell never got an answer to that question, but he did get the double charge removed. He also doesn’t have clarity on why Frankie couldn’t have just been seen at the urgent care to rule out a concussion, especially when other family members had been seen at that kind of clinic.

R COOK: Frankie’s grandmother was in a car accident, went to the urgent care near her house, was checked out – fine – $200 bill. That’s kind of what I was expecting.

WHITEHEAD: Russell says after insurance, he owes about $1,000 for Frankie’s ER visit. On advice from an attorney friend, he still hasn’t paid even all these months later because he still has unanswered questions about Frankie’s bill. I’m Sam Whitehead in Rome, Ga.

SUMMERS: OK, Dr. Rosenthal. This raises some really big questions for me, too. What happened here with Frankie being turned away from urgent care?

ROSENTHAL: Well, here’s the thing. Urgent care centers can turn people away. They’re not subject to a federal law called EMTALA that says emergency rooms have to see anyone who shows up regardless of their insurance or their ability to pay. The law allows the urgent care centers to be a lot choosier. And this one chose not to treat someone on the basis of the possibility of auto insurance being involved. And let’s be clear here, too. The clinic didn’t say, we can’t treat your kind of injury. They said, we won’t treat you because of your insurance.

SUMMERS: So is that what the receptionist was talking about when she said third-party insurance?

ROSENTHAL: Yeah. People need to know that if you’ve been in an accident, really, of any kind, even slipping in your own bathtub, there’s a chance that your health insurance is going to try to get another kind of insurance – say, home or auto – to pay your medical bills first. And while urgent care centers have contracts with medical insurers, getting home or auto insurance to pay up may be a big hassle involving lawyers and delays. So they kind of want to avoid that.

SUMMERS: OK. So the other thing that stuck out to me here is that this emergency room was just a mile away and owned by the same company as the urgent care.

ROSENTHAL: Well, generally speaking, hospitals do use these omnipresent urgent care centers to create a kind of pipeline of referrals – you know, new patients they can send to the hospital. But I’m not sure you can invoke that kind of conspiracy in this particular case.

SUMMERS: So what should patients know about visiting these two sites?

ROSENTHAL: There are a few important things – first, that the ER is likely to be exponentially more expensive than urgent care. So try urgent care first. Also, in the ER, you’ll get far more testing just because you’re there, whether it’s absolutely needed or not. So if an urgent care clinic suggests they can’t treat you for whatever reason and suggests, oh, just go to the ER, ask instead for a referral to a doctor or a specialty clinic. You’re going to save a whole lot of money.

SUMMERS: All right. That’s some good advice. Dr. Elizabeth Rosenthal, thank you for being here.

ROSENTHAL: Thanks for having me again.

SUMMERS: And if you have an outrageous or just confusing medical bill, go to NPR’s Shots blog and tell us all about it.

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