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Tackling Surprises in Urgent Care Billing

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In the US healthcare scenario, Urgent Care Centers occupy a position of unique importance. They are the preferred destination when medical attention is needed on an urgent basis. Falling just short of Emergency Rooms in terms of the scope of services rendered, Urgent Care facilities provide a quick and inexpensive means of receiving a modest range of medical treatments. Quick, yes. But we are not too sure about the ‘inexpensive’ part. This is because when it comes to Urgent Care billing, there is no dearth of horror stories.

It often happens that a patient walks into an Urgent Care Center with some sort of a medical emergency. If the center is authorized to treat the problem, the patient is attended to without further delay. But when the bill arrives, it may pack in a surprise. The patient often finds himself facing a huge bill that his insurance will not cover because he was treated by a physician who is not in-network. It could also happen in the case a test sample was sent to a lab that is out of network.

Recent legislature by the Biden government aims to address the problem with such ‘surprise billing’. A new law came into force from January 1, 2022. But like most laws, it’s not foolproof. As healthcare centers such as hospitals, labs and Urgent Care centers still struggle to come to terms fully with the new law, or the ‘No Surprise Act’ gets understood by all concerned, patients are likely to continue receiving a surprise bill every now and then.

The problem is most acute with those under a commercial or private insurance plan. Take the case of a patient in New York who recently suffered a wound from a falling object and got treated at a nearby Urgent Care Center, only to receive the shock of his life when he was sent a bill for $1,000+ because he was given stitches by a visiting plastic surgeon who, yes you guessed it, was not in-network. The patient’s insurance carrier refused to entertain any claims for compensation.

So what can we do to eliminate such unpleasant surprises? The most sound advice is to ask upfront if the Urgent Care Center you are planning to visit, is included in the payor’s network. The main idea is to try and understand if the treatment you are planning to undergo will entail expenses that are not covered by your insurance plan. Relax, most Urgent Care Centers will clearly state if extra out-of-pocket charges are going to be involved, and will provide options to use stay completely in-network or step out of the Golden Circle, but knowingly.