After Frankie Cook’s car crash on a wet road outside Rome, Ga., her father Russell (right) received a letter from a lawyer saying hospital emergency rooms owe more than $17,000 for imaging and testing to determine if she had a concussion .
Audra Melton for KHN
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After Frankie Cook’s car crash on a wet road outside Rome, Ga., her father Russell (right) received a letter from a lawyer saying hospital emergency rooms owe more than $17,000 for imaging and testing to determine if she had a concussion .
Frankie Cook remembers last year’s car accident only in flashbacks.
She was driving a friend home from high school on a winding road outside Rome, Ga. She saw standing water from the recent rain. She tried to slow down but lost control of the car in a big bend. “The car flipped about three times,” says Frankie. “We swerved and went off the side of that hill. My car was on its side and the rear end was crushed into a tree.”
It sounds bad, but Frankie says the airbags deployed and both passengers were wearing their seat belts, so she only had a headache when dad Russell Cook came to pick her up from the scene.
Frankie Cook was driving a friend home from high school when her car veered off a winding country road and overturned several times, hitting a tree. Frankie escaped serious injury, but her family quickly ran into a new problem after she was turned away from an emergency clinic due to insurance.
Russell Cook
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Frankie Cook was driving a friend home from high school when her car veered off a winding country road and overturned several times, hitting a tree. Frankie escaped serious injury, but her family quickly ran into a new problem after she was turned away from an emergency clinic due to insurance.
Frankie, then a high school senior, was worried she might have a concussion that might affect her performance on an upcoming Advanced Placement exam, so she and her father decided to have her stop by an emergency center near their house to get checked out. They didn’t make it past the front desk.
“We don’t accept third-party insurance,” Russell says the receptionist at Rome’s Atrium Health Floyd Urgent Care told him, though he wasn’t sure what she meant. “She told me about three times.”
The problem didn’t seem to be that the clinic didn’t have enough medical knowledge to evaluate Frankie, and the family has good health insurance. However, if the injuries are the result of accidents, another insurance company, such as auto or home, may be primarily responsible for the medical bills. Health insurance, if it’s on the hook at all, can kick in when another insurance company pays.
The Cooks appeared to be facing a refund policy often used by urgent care centers to avoid waiting on payments from auto insurance settlements.
Russell is ordered to take Frankie to the emergency room, which by law is required to see all patients, regardless of such problems. The closest, at Atrium Health Floyd Medical Center, was about a mile down the road and owned by the same hospital system as the emergency center.
Russell says the doctor there looked at Frankie “just for a few minutes,” did a precautionary CT scan of her head and body, and sent her home with advice to “take some Tylenol” and rest. She did not have a concussion or serious head injury and was able to pass the AP exam on time.
Patient: Frankie Cook, 18, now a freshman from Rome, Ga.
Medical services: medical examination and two CT scans.
Service Provider: Atrium Health Floyd, a hospital system with urgent care centers in northwest Georgia and northeast Alabama.
Total bill: $17,005 for ER visit; It was later adjusted to $11,805 after the duplicate charge was removed.
What it gives: The Cooks find themselves in jeopardy in the health care system after Frankie’s car crashes into that tree: More and more hospital systems own urgent care centers that have restrictions on who they treat — both for financial and medical reasons .
Russell was quite upset to receive such a high bill, especially when he was trying to make a quick and cheap trip to the clinic. He said Frankie’s grandmother was seen at the urgent care center after a recent car accident and left with a bill for just a few hundred dollars.
“I kind of expected that,” he says. “She really needed to be examined.”
So why was Frankie turned away from the ER?
Lou Ellen Horwitz, executive director of the Urgent Care Association, says it’s pretty standard policy for urgent care centers not to treat injuries resulting from car accidents, even minor ones. “They generally don’t cover car accident victims, regardless of the extent of their injuries, because it goes through the auto insurance claims process before the provider gets paid,” he says.
Horwitz says urgent care centers — even those owned by large health systems — often operate on thin margins and can’t wait months and months for an auto insurance company to pay a claim. He says that “unfortunately” people tend to find out about such policies when they show up and expect care.
Fold in the complex relationship between health and auto insurance companies and you have what Barak Richman, a professor of health care policy at Duke University Law School, calls “a wonderfully complicated world we live in.”
“Each product has its own specifications about where it goes and what it covers. Each one is extremely difficult and complex to manage,” he says. “And each imposes errors on the system.”
Atrium Health did not respond to repeated requests for comment on Frankie’s case.
Horwitz rejects the idea that the health care system might push people in car wrecks out of urgent care centers and into emergency rooms in order to make more money off of them. However, auto insurance generally pays more than health insurance for the same services.
“At the risk of sounding too cynical, there are always dollar signs when a healthcare provider sees a patient coming through the door,” says Richman.
dr. Ateev Mehrotra, a professor of health care policy at Harvard Medical School, says it was probably strategically important to have the urgent care center right down the street from the emergency room. Part of the strategy makes sense from a medical perspective, he says, “because if a bad thing happens, you want to get them somewhere with more skills really quickly.”
But he also says that urgent care centers are “one of the most effective ways” for the health system to generate new revenue, creating a pool of new patients who visit its hospitals and later see doctors for testing and follow-up.
Mehrotra also says that urgent care centers are not bound by the Emergency Medical Care and Labor Act, a federal law known as EMTALA that requires hospitals to stabilize patients regardless of their ability to pay.
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At the time of Frankie’s visit, the urgent care center and emergency room were owned by the Floyd Health System, which operated a handful of hospitals and clinics in northwest Georgia and northeast Alabama. To see also : Car Insurance for Teens. Floyd has since merged with Atrium Health, a larger North Carolina-based company that operates dozens of hospitals across the Southeast.
Frankie had a CT scan of her head and body in the emergency room, and KHN tests confirmed that she wouldn’t be able to make it to the emergency center—whether the test was medically necessary or just part of the protocol for people in car wrecks who complain of headaches.
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Solution: Sixteen months have passed since Frankie Cook’s hospital visit and Russell, on the advice of a family friend who is a lawyer, has put off paying any bills until the remaining uncertainties are resolved. To see also : St. Petersburg Car Insurance: Best Cheap Rates (2022). After insurance covered their share, the Cooks’ share was $1,042.
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Getting to that number was a frustrating process, says Russell. He learned of the initial $17,005 bill in a letter from the attorney representing the hospital — another disturbing result of Frankie’s car accident. To see also : What happens if someone hits your car and drives off?. The Cooks then had to go through a lengthy appeals process to have the $5,200 duplicate charge removed from their account.
In the end, Anthem Blue Cross Blue Shield, the Cooks’ health insurance company, paid $4,006 of the claim. They said in a statement that they are “committed to providing access to high-quality health care for our members. This matter was reviewed in accordance with our clinical guidelines and billed claims were processed accordingly.”
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“It’s not going to put us on the street,” Russell says of the $1,042 balance, “but we have expenses like everyone else.”
He added, “I’d be happy to go to urgent care for $200, but that ship has sailed.”
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| Bottom line: It’s important to remember that urgent care centers are not subject to the same laws as emergency rooms and can be more selective about who they treat. Sometimes their reasons are financial, not clinical. | It’s not uncommon for urgent care centers—even those in large health systems—to turn away people who have been in car accidents because of complications from auto insurance settlements. |
|---|---|
| Although urgent care visits are less expensive than an emergency room visit, clinics often cannot offer the same level of care. And you may have to pay for an urgent care visit only to find out you need further care in the emergency room. Then you could be stuck with two accounts. | Bill of the Month is a massive survey by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill that you want to share with us? Tell us about it! |
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