Skip to main content

How to avoid urgent care sticker shock

When you walk into any given urgent care center, two things matter: who owns it and what insurance you have.

Urgent care centers are walk-in clinics where you can get care for medical problems you might otherwise go to an emergency room for - like a broken ankle or an asthma attack - but without the long waits and high costs.

Now numbering almost 10,000, there are more urgent care centers in the U.S. than emergency rooms - and that ratio is likely to tip much higher in the next few years as hospitals cut costs: the number of urgent care centers could hit 12,000, according to the research firm IBISWorld.

Even if the back of your insurance card states clearly that an urgent care visit will cost you a fixed-amount co-pay (anywhere from $30 to $100), there could also be charges for individual procedures, facility fees or other add-ons.

 

Figuring out costs is even more challenging for those with co-insurance, where you pay a percentage of every charge, or high-deductible health plans, where you pay out of pocket until you reach a limit somewhere north of $1,250 for an individual.

When it comes to costs, "it's difficult for patients to do the whole triage thing," says Ateev Mehrotra, a policy analyst at the RAND Corporation, a nonprofit think tank.

INITIAL VISIT COSTS

The reasons prices vary so much is that there is extreme fragmentation in the urgent care business, which produced $14.5 billion in revenue in 2012 and is projected to grow to $18 billion by 2018, according to IBISWorld.

No entity controls more than 1 percent of the market - among the largest, Concentra Inc., now owned by Humana Inc, has 320 locations, NextCare Urgent Care Inc. has 58 and FastMed Inc. has 40.

They all set their own pricing, and have varying rates they've negotiated with insurance companies, a process that will not change with upcoming healthcare reform. (For those who have no insurance at all, there is a different schedule of fees altogether.)

In St. Louis, for example, out-of-pocket fees for an initial visit range from $89 at the three locations of Total Access Urgent Care, owned by Dr. Matt Bruckel, to $277 for one of the four urgent care locations run by St. Anthony's Medical Center (with a 40 percent discount if you pay cash upfront).

At the two locations owned by Dr. Sonny Sugar, Downtown Urgent Care and Eureka Urgent Care, he offers a $67 per month membership.

"The worst thing is the uncertainty about what one's bill will be," Sugar says. Patients at his facilities receive an itemized list of costs before treatment, he says.

Hospitals run about 26 percent of urgent care centers nationwide, but sometimes consumers find out after the fact that their visit was actually billed as an ER visit, or they are charged a "facility fee," which can run in the hundreds of dollars. This results in sticker shock for some patients.

When Chrisi Tainter's son was on a trip and needed stitches, she ended up with a $600 bill for an ER-type facility. As a medical billing manager for Our Urgent Care Centers in St. Louis, she knows exactly what it would have cost with her insurance if he had been treated at her own place of employ: $140.

PROCEDURE CHARGES

_0">

For many patients, the initial visit charge will be all that they pay. If prescribed antibiotics for an ear infection, they'll walk out with a slip of paper and the certainty that they won't end up in medical collections.

_1">

All other services are a la carte. At urgent care facilities run by Bruckel, it costs $41 for the first procedure (like stitches or setting a fracture) and $30 for subsequent ones, with higher fees for things like a CT scan or vaccinations.

_2">

If a patient comes in with suspected pneumonia, gets intravenous fluids, a nebulizer treatment and a $60 x-ray, she could end up with a total bill of $210, Bruckel says, adding that it's less than the $277 at competitors just to see a doctor.

_3">

The hospital-run centers, for their part, say they base their charges on insurance rates, and by ability to pay for those who are uninsured.

_4">

TOTAL BILLS

_5">

Among St. Louis' independently-owned urgent care centers, billing manager Tainter says she has never seen a patient get a bill for over $500. Most bills are under $100, and some are between $100 and $300.

_6">

The best way to try to assess your potential costs before you go to an urgent care center is to check with your insurance company. You can also check a cost estimator online or on a mobile app.

_7">

The one for UnitedHealth Group Inc allows you to put in a condition, like a sprained ankle, and get an estimate of costs for treatment at all the local options, allowing the customer to compare prices for primary care doctors, urgent care centers and emergency rooms, says Victoria Bogatyrenko, vice president of product innovation for United Healthcare.

_8">

In 15 months, the tool has delivered $100 million worth of estimates for care, the company says.

_9">

You can also call around to the urgent care centers in your area to ask about pricing - if the situation allows you the time.

_10">

Just don't expect them to be able to answer all your questions. "The receptionist will not know, because they won't know what treatment is going to be," Tainter says.

_11">

Medical treatment is still personalized - so the specifics of your bill are going to depend on what's wrong with you and what procedures you get.

_12">

(This version of the story corrects the amount in paragraph 22 to $100 million, from $100,000 million, as previously mentioned.)

_13">

(Follow us @ReutersMoney or here. Editing by Lauren Young and Andrew Hay)

_14">

Popular posts from this blog

Study Abroad USA, College of Charleston, Popular Courses, Alumni

Thinking for Study Abroad USA. School of Charleston, the wonderful grounds is situated in the actual middle of a verifiable city - Charleston. Get snatched up by the wonderful and customary engineering, beautiful pathways, or look at the advanced steel and glass building which houses the School of Business. The grounds additionally gives students simple admittance to a few major tech organizations like Amazon's CreateSpace, Google, TwitPic, and so on. The school offers students nearby as well as off-grounds convenience going from completely outfitted home lobbies to memorable homes. It is prepared to offer different types of assistance and facilities like clubs, associations, sporting exercises, support administrations, etc. To put it plainly, the school grounds is rising with energy and there will never be a dull second for students at the College of Charleston. Concentrate on Abroad USA is improving and remunerating for your future. The energetic grounds likewise houses various

Best MBA Online Colleges in the USA

“Opportunities never open, instead we create them for us”. Beginning with this amazing saying, let’s unbox today’s knowledge. Love Business and marketing? Want to make a high-paid career in business administration? Well, if yes, then mate, we have got you something amazing to do!   We all imagine an effortless future with a cozy house and a laptop. Well, well! You can make this happen. Today, with this guide, we will be exploring some of the top-notch online MBA universities and institutes in the USA. Let’s get started! Why learn Online MBA from the USA? Access to More Options This online era has given a second chance to children who want to reflect on their careers while managing their hectic schedules. In this, the internet has played a very crucial in rejuvenating schools, institutes, and colleges to give the best education to students across the globe. Graduating with Less Debt Regular classes from high reputed institutes often charge heavy tuition fees. However onl

Sickening moment maskless 'Karen' COUGHS in the face of grocery store customer, then claims she doesn't have to wear a mask because she 'isn't sick'

A woman was captured on camera following a customer through a supermarket as she coughs on her after claiming she does not need a mask because she is not sick.  Video of the incident, which has garnered hundreds of thousands of views on Twitter alone, allegedly took place in a Su per Saver in Lincoln, Nebraska according to Twitter user @davenewworld_2. In it, an unidentified woman was captured dramatically coughing as she smiles saying 'Excuse me! I'm coming through' in the direction of the customer recording her. Scroll down for video An unidentified woman was captured dramatically coughing as she smiles saying 'Excuse me! I'm coming through' in the direction of a woman recording her A woman was captured on camera following a customer as she coughs on her in a supermarket without a mask on claiming she does not need one because she is not sick @chaiteabugz #karen #covid #karens #karensgonewild #karensalert #masks we were just wearing a mask at the store. ¿ o