Hospital based Urgent Care Facility Fees – How to be an educated healthcare consumer, especially if you have a high deductible.
Urgent Care Facility Fees & Overtesting – how to be an educated healthcare consumerAll urgent cares do not charge the same, especially those that are affiliated with hospitals. While STLHealthworks.com does not charge expensive facility fees, most other centers, especially hospital-owned urgent care centers, do. Hospitals run about 26 percent of urgent care centers nationwide. Patients of some of these hospital-owned centers are often surprised when they get their bill and see that they were billed as an ER visit or charged a facility fee.
Overtesting & Overtreatment
Worse, many urgent cares will try to use the expensive equipment and resources they own. If they own an ER, they'll try to transfer you there "because it's safer". If they own a CT scanner or ultrasound machine, they'll try to use it on you "just to be sure". Your headache, sore throat, bladder infection, laceration and abdominal pain will typically not require such expensive testing, according to evidence based medicine. What's the harm to the patient of overtesting? Three things: 1. Higher Cost 2. Harmful Radiation 3. More worry.
What exactly is a “facility fee”?
A facility fee is a charged to the patient by the hospital in addition to the professional fee. For example, if you see a doctor at a hospital’s urgent care for bronchitis, you expect to pay the 'professional fee' bill, which is for the person who attended your case, such as the Doctor or Nurse Practitioner at a private urgent care center. However, hospitals will also charge another separate fee. This is known as a 'facility fee'. In urgent care medicine, these facility fees typically average -' additional $200. This fee is in addition to the professional fee part of your bill.
Patients are waking up to this, and have begun to fight facility fees, and some state legislators have proposed bans. Unfortunately, none have become law yet because of the powerful 'non-profit' hospital lobby. These fees routinely add hundreds of dollars to a patient’s bill. This adds out-of-pocket costs for those who have an increasingly common, high-deductible insurance plan, which may require a patient to pay $2,500 or more toward her medical bills before the coverage kicks in.
What can you do about it?
Determine if the urgent care center you are considering utilizing is owned by a hospital. Then, call and ask if they charge a facility fee in addition to the professional fee. Also, you should ask if they own a CT scanner onsite. You can check their website, but the information may not be there. If the receptionist is unsure, ask to be connected to their billing office.
What if you have a high deductible?
If you or your family has a high deductible (over $1,000) but are frequent visitors to the urgent care or primary care office, then you've probably noticed that your monthly premium is just the beginning, rather than the end of your medical bills.
That's why we recommend DirectYourCare.com to our high deductible patients. With this program, you proudly keep your highest deductible lowest premium (aka catastrophic) insurance policy, but you put a cap on other out-of-pocket costs, at around $59/month, no matter how complex the visit, but this is only for primary care and urgent care visits.
In summary, be informed about professional fees, facility fees, overtesting (such as with CT scans and ER transfers), and look at other solutions for your high deductible.