Turned away from emergency medical care — and to a great extent the ambulance bill

Frankie Cook remembers last year’s car accident only in flashes.

She was driving a friend home from school on a winding road outside Rome, Georgia. She saw standing water from the recent rain. She tried to brake, but lost control of the car on a sharp turn. “The car flipped about three times,” Frankie said. “We turned around and left the hill. My car was on its side and the rear was crushed against a tree.’

Frankie said the airbags deployed and both passengers were wearing seat belts, leaving her with only a headache when her father, Russell Cook, came to collect her from the scene.

Frankie, then in high school, worried that she might have a concussion that might affect her performance on an upcoming Advanced Placement exam, so she and her father decided to go to the urgent care center near their home to get her checked out. . They didn’t make it past the check-in desk.

“We don’t accept third-party insurance,” Russell said in the reception area Atrium Health Floyd Urgent Care Rome she told him, though he wasn’t sure what she meant. “She told me, like, three times.”

Urgent Care Clinics vs. EMS

The problem doesn’t seem to be that the clinic lacks the medical expertise to evaluate Frankie. Rather, it appeared that the Cooks were facing a reimbursement policy often used by urgent care centers to avoid waiting for auto insurance payouts.

Russell was told to take Frankie to the emergency room, which by law is required to see all patients, regardless of such problems. Nearest, art Atrium Health Floyd Medical Centerwas about a mile down the road and belonged to the same hospital system as the urgent care center.

There, Russell said, the doctor examined Frankie “for just a few minutes,” did a warning CT scan of her head and body, and sent her home with the advice to “take some Tylenol” and rest. She did not have a concussion or major head injury and was able to pass her AP exam on time.

Then came the bill.

Patient: Frankie Cook, 18, is currently a college freshman from Rome, Georgia.

Medical services: Medical examination and two CT scans.

Service provider: Atrium Health Floyd, a hospital system with urgent care centers in northwest Georgia and northeast Alabama.

Total account: $17,005 for emergency room visits; It was later adjusted to $11,805 after the duplicate charge was removed.

Which gives: After Frankie’s car crashes into a tree, the Cooks are faced with a health care system with more and more hospital systems owning urgent care centers that have restrictions on who they can treat – both financially and medical reasons.

Russell was very 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 in the emergency room after a car accident and walked out with a bill of just a few hundred dollars.

“This is what I expected,” he said. “She just needed to be examined.”

So why was Frankie turned away at the urgent care center?

Lou Ellen Horwitz, CEO of the Emergency Medical Services Association, said that urgent care centers do not typically treat injuries sustained in car accidents, even minor ones. “Typically, they don’t care about car accident victims regardless of the extent of their injuries because they’re going to go through that auto insurance process before the provider gets paid,” she said.

Thin margins

Horwitz said urgent care centers — even those owned by large health systems — often operate on low margins and cannot wait months and months for an auto insurance company to pay a claim. She said that, “unfortunately,” people tend to find out about such policies when they show up waiting for help.

Fold inside complex relationship between medical and auto insurance companies and you have what Barack Richmanprofessor of health policy at Duke University Law School, called it “a wildly complex world we live in.”

“Each product has its own specifications as to where it goes and what it covers. Each one is incredibly complex and difficult to administer,” he said. “And each of them imposes errors on the system.”

Atrium Health did not respond to repeated requests for comment on Frankie’s case.

Profit strategy?

Horvitz dismissed the idea that the health care system might push accident victims out of urgent care centers and into emergency rooms to make more money off of them. However, auto insurance usually pays more than health insurance for the same services.

Richman remained skeptical.

“At the risk of sounding overly cynical, there are always dollar signs when a healthcare professional sees a patient walk through the door,” Richman said.

Dr. Ateyev Mehrotra, a professor of health policy at Harvard Medical School, said it’s probably strategic for an urgent care center to be right down the street from an emergency room. Part of the strategy makes sense from a medical standpoint, he said, “because when something bad happens, you want to get them to a place with more skill very quickly.”

But he also said that urgent care centers are “one of the most effective ways” for the health system to generate new revenue by creating a pipeline of new patients who visit its hospitals and then see doctors for tests and follow-up.

Mehrotra also said urgent care centers are not bound by the Emergency Medical Services and Labor Act, a federal law known as EMTALA which requires hospitals to stabilize patients regardless of their ability to pay.

At the time of Frankie’s visit, both the urgent care center and the emergency department were owned by the Floyd Health System, which operates several hospitals and clinics in northwest Georgia and northeast Alabama. Since then, Floyd united with Atrium of health is the largest company in North Carolina that operates dozens of hospitals in the Southeast.

Frankie had a CT scan of her head and body in the emergency room, KHN’s tests confirmed that she could not have been admitted to the emergency room, whether the scan was medically necessary or just part of the protocol for people admitted to accident, who complain of a headache.

permission

Sixteen months have passed since Frankie Cook’s hospital visit, and Russell has put off paying the bill on advice he received from a family friend who is a solicitor. After insurance covered their share, the Cooks’ share was $1,042.

Getting to that number was frustrating, Russell said. He heard about the original $17,005 bill in a letter from a lawyer representing the hospital—another troubling wrinkle in Frankie’s car-accident recovery. The Cooks then had to go through a lengthy appeals process to get the $5,200 duplicate charge removed from the account.

Anthem Blue Cross Blue Shield, the Cooks’ insurance company, paid $4,006 on the claim. The statement said it “is committed to ensuring access to high-quality healthcare for our members. This matter has been reviewed in accordance with our clinical guidelines and billed claims have been processed accordingly.”

“It’s not going to put us out on the street,” Russell said of the $1,042 balance, “but we have expenses like everybody else.”

He added: “I’d like to get the $200 emergency, but that ship has sailed.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and surveying, KHN is one of the three main operating programs in the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.