Free-standing ER clinicsMore than 400 free-standing emergency departments (EDs) are operating in US suburbs, where more people are insured by commercial health plans rather than covered by Medicaid. These ER “pop-ups” would likely lose money if they billed Medicaid with its much lower rates, if they even accept Medicaid and Medicare (some facilities don’t). These clinics have been open for about five years and already health insurer Aetna is suing two Texas centers for fraud. This is the second lawsuit Aetna filed - the first was settled for an undisclosed amount.
These freestanding EDs typically charge triple above that of urgent care centers. American Medical News (April 2013) reported that average net revenue per patient for urgent care centers ranges from $105 to $135, while average revenue is $350 to $500 for freestanding EDs. Co-pays for urgent care go from $35 to $50 compared with $75 to $100, according to the Urgent Care Association.
A major complaint is that these EDs treat minor health problems, just like urgent care clinics - also known as “doc in a box,” but charge emergency room fees.
Hospital emergency rooms
Countless insurers are unaware that ERs charge double or triple the amount per patient than an urgent care center or doctor’s office - until they tally all the bills. A patient is typically presented with an invoice when leaving the ER and, to his or her surprise, other bills pour in later.
“We recently moved to the US and when my son got sick we didn’t yet have a doctor so we drove to the nearest hospital,” says Paula, from Spain. “He was in the ER room for less than an hour, including time it took for an x-ray, and we left with a prescription to treat the ‘flu’ and an ER charge of $200, which we thought was okay but it would have been less in Spain. Two weeks later we received a $475 bill for ‘Emergency Department visit moderate severity.’ It said we had 15 days to pay to avoid penalties. We were shocked, but paid it anyway. Imagine our shock when we just got another bill for $800, this time for the ER bed and pharmacy charges. My son must have been on that bed for mere minutes. And charges for a flu prescription? This is outrageous.”
Charlie went to the emergency room with what he thought was a lung infection, but he was also diagnosed with the ‘flu.’ Charlie knew that urgent care would be about one-third the cost, but it was Christmas Day and in Kentucky, at least in his neighborhood, they were closed for the holiday. After waiting for three hours in the waiting room and another two hours in the ER, a nurse did a swab test for ‘flu.’
“After they determined I simply had the flu, I had an x-ray to rule out pneumonia and they put me on IV in case I was dehydrated - both procedures were unnecessary,” Charlie says. “After all that, my wife and I saw the doctor for a few minutes and he then sent us on our way. They know we aren’t insured and that added to the anger and shock when a bill came for $2,300 - and that was just for the bed. One week later we received another bill in the mail, this time a $60 radiology charge for the x-ray, which was the only charge that was reasonable. Under that charge was the doctor’s fee, to the tune of $1,055, or more than $200 per minute. I just about had a stroke.”
Charlie spoke to the hospital administrator and found out that he doesn’t qualify for any Medicare or assistance. They negotiated 10 percent off if the total is paid within 30 days and if not, it goes to a collection agency. In hindsight, Charlie says he should have left the ER when he was diagnosed with the flu. Doctors tend to err on the safe side, seemingly ordering unnecessary tests when treating ER patients because there is a real fear of malpractice litigation. Still, it isn’t fair that this fear comes down to the patient.
At the same time, the more tests and procedures administered (usually to privately insured people) allow more opportunities for hospital overcharging.
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“Even if I flew business class, it would still cost much less in Europe or the UK for just about any treatment or procedure,” she says.
“I was vacationing in Amsterdam a few years ago and became sick with a respiratory infection. My hotel called a doctor who even came to the hotel, examined me and prescribed a heavy-duty antibiotic. I was better in a few days and my bill, including the prescription, was about $50. If this happened at home in the US, add another three digits to that price.
We need more attorneys to help Americans fight these criminal overcharges, some of whom have been bankrupted because of emergency room costs. Only in America.”