Many finance-savvy patients are eschewing emergency rooms in favor of urgent care, expecting it will save them money. Yet they are still getting hit by surprise medical bills, Kaiser Health News has reported.
That was the case with Sallyann Johnson, who asked all sorts of questions about whether the urgent care center near her home in Milwaukee, Wisconsin, accepted her insurance. Nevertheless, she was still hit with a $356 doctor's bill. "I felt I asked all the right questions. I even re-asked the questions," Johnson told Kaiser Health News.
The issue is that many urgent care centers may say they accept coverage from major insurers, but may not necessarily disclose if they're actually within an insurer's provider network, potentially causing confusion for patients, according to Kaiser Health News. That prompted the New York attorney general to contact operators of urgent care centers and ask them to post specific information about their network relationship with health plans.
Surprise bills--when patients unwittingly use out-of-network providers thinking they were fully covered by their insurers--have been growing in recent years. That's partly because contractual arrangements between payers and providers change constantly, and patients may not always be made aware of such changes in a timely fashion. Surprise bills can even hit patients who receive care at in-network providers, the Los Angeles Times reported.
New York recently passed one of the strictest laws in the country regulating surprise bills for consumers seeking care in hospitals and medical offices, and it is considered a model for other states. New Jersey and Connecticut lawmakers are wrangling with legislation along similar lines.
The move by New York's attorney general regarding urgent care clinics was applauded by consumer advocates. "If we're seeing it in New York, we're probably seeing it in other states, too," Blake Hutson, interim director of health reform at Consumers Union, told Kaiser Health News.