The ER scanned her after a automotive accident. She was nice, however the invoice was $17,000 : NPR

JUANA SUMMERS, HOST:

It is time now for our Medical Invoice of the Month. And Dr. Elisabeth Rosenthal is editor-in-chief of our accomplice Kaiser Well being Information and is with us to speak about pressing care, emergency care and the way these two websites of remedy work together. Dr. Rosenthal, welcome again.

ELISABETH ROSENTHAL: Thanks. It is good to be right here.

SUMMERS: So inform us. Who’re we assembly at present?

ROSENTHAL: Immediately we meet the Cook dinner household of Rome, Ga. The dad is Russell Cook dinner, and his daughter is Frankie, who’s a university freshman now. After Frankie was in a automotive accident, they came upon that one big distinction between pressing care and emergency room care is the dimensions of the invoice. And that is true for a similar affected person and the identical affected person grievance.

SUMMERS: Oh, gosh. This doesn’t sound good. KHN reporter Sam Whitehead visited the Cooks. Let’s take heed to their story.

SAM WHITEHEAD: Frankie Cook dinner remembers final yr’s automotive accident in flashes. She was driving a good friend residence from highschool on a winding nation highway. She noticed standing water and tried to decelerate however hydroplaned.

FRANKIE COOK: The automotive flipped about thrice. We spun round and went off the aspect of this hill. And so my automotive was on its aspect, and, like, the again finish was crushed up right into a tree.

WHITEHEAD: Frankie and her good friend had been sporting seatbelts when the automotive’s airbags deployed, so no one was significantly damage when the police and Frankie’s dad Russell acquired there.

RUSSELL COOK: The entire adults had been type of amazed that they had been OK.

WHITEHEAD: However it seemed dangerous sufficient.

R COOK: Oh, it seemed terrifying. Yeah. They had been fortunate to have simply walked away.

WHITEHEAD: Frankie was nice apart from a little bit of a headache and a fear she simply could not shake.

F COOK: I simply was involved, due to the character of the wreck, that I had a concussion of some kind. And I had an AP examination two days later, my AP physics examination. And so I used to be like, I do not wish to, you already know, take that with a concussion.

WHITEHEAD: So the Cooks went to an pressing care clinic. Russell advised a receptionist there that Frankie had been in a automotive accident and he’d prefer to have her checked out.

F COOK: They usually stated, oh, we do not take third-party insurance coverage. And it made no sense to me. And she or he advised me, like, thrice, we do not take third-party insurance coverage. It’s important to go to the hospital for that.

WHITEHEAD: The closest ER was a couple of mile down the highway and owned by the identical firm because the pressing care.

F COOK: They’re all fairly shut collectively. It is a lot simpler to simply go to the one which’s proper there, that is owned by the identical individuals.

WHITEHEAD: Two CT scans got here again clear – no concussion or different inner accidents. And Frankie was despatched residence with directions to take it straightforward for a number of days. She handed her AP examination, by the way in which. So Russell was shocked when he acquired a letter from the hospital’s lawyer saying it was $17,000 for the ER go to.

R COOK: I used to be pissed, I imply, actually, you already know, type of up in arms. Why did I get a $17,000 invoice?

WHITEHEAD: Russell pushed the hospital for a breakdown of the invoice. There was a reproduction $5,000 trauma evaluation charge, and Frankie was billed for a Degree IV ER go to, the second highest degree of severity.

R COOK: She walked in and walked out and was advised to take some Tylenol, you already know? So I simply wished to know why was she billed as that as a result of I’ve acquired to pay for it.

WHITEHEAD: Russell by no means acquired a solution to that query, however he did get the double cost eliminated. He additionally does not have readability on why Frankie could not have simply been seen on the pressing care to rule out a concussion, particularly when different relations had been seen at that type of clinic.

R COOK: Frankie’s grandmother was in a automotive accident, went to the pressing care close to her home, was checked out – nice – $200 invoice. That is type of what I used to be anticipating.

WHITEHEAD: Russell says after insurance coverage, he owes about $1,000 for Frankie’s ER go to. On recommendation from an legal professional good friend, he nonetheless hasn’t paid even all these months later as a result of he nonetheless has unanswered questions on Frankie’s invoice. I am Sam Whitehead in Rome, Ga.

SUMMERS: OK, Dr. Rosenthal. This raises some actually massive questions for me, too. What occurred right here with Frankie being turned away from pressing care?

ROSENTHAL: Effectively, this is the factor. Pressing care facilities can flip individuals away. They are not topic to a federal regulation known as EMTALA that claims emergency rooms should see anybody who exhibits up no matter their insurance coverage or their potential to pay. The regulation permits the pressing care facilities to be so much choosier. And this one selected to not deal with somebody on the premise of the potential of auto insurance coverage being concerned. And let’s be clear right here, too. The clinic did not say, we won’t deal with your type of harm. They stated, we cannot deal with you due to your insurance coverage.

SUMMERS: So is that what the receptionist was speaking about when she stated third-party insurance coverage?

ROSENTHAL: Yeah. Individuals have to know that when you’ve been in an accident, actually, of any form, even slipping in your individual bathtub, there’s an opportunity that your medical health insurance goes to attempt to get one other type of insurance coverage – say, residence or auto – to pay your medical payments first. And whereas pressing care facilities have contracts with medical insurers, getting residence or auto insurance coverage to pay up could also be an enormous problem involving attorneys and delays. In order that they type of wish to keep away from that.

SUMMERS: OK. So the opposite factor that caught out to me right here is that this emergency room was only a mile away and owned by the identical firm because the pressing care.

ROSENTHAL: Effectively, typically talking, hospitals do use these omnipresent pressing care facilities to create a type of pipeline of referrals – you already know, new sufferers they’ll ship to the hospital. However I am undecided you’ll be able to invoke that type of conspiracy on this specific case.

SUMMERS: So what ought to sufferers learn about visiting these two websites?

ROSENTHAL: There are a number of vital issues – first, that the ER is more likely to be exponentially dearer than pressing care. So attempt pressing care first. Additionally, within the ER, you may get much more testing simply since you’re there, whether or not it is completely wanted or not. So if an pressing care clinic suggests they can not deal with you for no matter cause and suggests, oh, simply go to the ER, ask as an alternative for a referral to a health care provider or a specialty clinic. You are going to save an entire lot of cash.

SUMMERS: All proper. That is some good recommendation. Dr. Elizabeth Rosenthal, thanks for being right here.

ROSENTHAL: Thanks for having me once more.

SUMMERS: And you probably have an outrageous or simply complicated medical invoice, go to NPR’s Pictures weblog and inform us all about it.

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