As free-standing emergency rooms (ERs) grow in number, they face a potential backlash over their high prices and allegations of fraud, according to the Fort Worth Star-Telegram.
The ERs are often located in high-traffic, high-income areas, although some prop up embattled rural healthcare systems, which is why Georgia lawmakers recently voted to allow them.
There are now 101 standalone ERs in Texas since the state implemented a 2010 licensing law. Like hospital ERs, much of their traffic comes from patients who could receive less expensive care from a doctor or urgent care facility, according to a 2010 National Institutes of Health study, which found such cases comprise nearly 30 percent of ER volumes, the Star-Telegram reported.
But some customers at free-standing ERs complain the facilities provide misleading pricing information. Daffney Cseke, who received a $1,800 bill along with her $100 co-pay after using Elite Care Emergency's Plano, Texas center, is one of the unhappy patients, according to the article. Cseke was told the center accepted her health insurance, Blue Cross Blue Shield of Texas, but did not ask if it was among her insurers' approved providers. Less than 50 percent of free-standing ERs in the Lone Star State have agreements with Blue Cross, although it is the state's largest insurer.
Health insurers now take action in response to what they see as confusing instructions from free-standing ERs like Elite Care Emergency. Blue Cross issued a reference guide warning of the high costs and the difference between the ERs and urgent care centers, while Aetna recently sued two free-standing ERs in the Houston area for $5.4 million, accusing them of running a scam to charge unjustified facilities fees.
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