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Urgent Care Wants Nearly a Thousand Dollars for a Visit! – Diane

“Dear Steve,

Our daughter has been having a chronic urinary track infection since the age of 3. Now at the age of 10 and dealing with the constant bed-wetting as well as the horrible smell that gets everyone (and not to mention her fragile tween self-esteem), I put my foot down at our normal pediatrician’s office. He agreed that it was time to go to the experts. He referred us to a specialist and she is with a local children’s hospital. We were instructed that the next time she has said infection, we are to go the urgent care affiliated with the hospital. We have excellent insurance so imagine our shock when we opened a bill from urgent care for $988.00 – and that is after insurance paying their “portion,” We think this is outrageous. What steps do you recommend that we do to check this out rather than simply blindly paying it??

Thank you!! Diane.

What steps do you recommend that we do to check this out rather than simply blindly paying it??

Diane”

Dear Diane,

I can only imagine how outraged and upset you are by the surprise bill.

The cost of modern U.S. medical care is out of control for the average person. Visits to the doctor can turn into giving medical practices an unaffordable blank check that leads to bankruptcy.

The first issue is to help dispel this myth that health insurance picks up everything or is responsible for the bill. Medical insurance is not for the benefit of the health care provider, but for the insured.

Meaning, the ultimate responsibility for the bill always rests with the patient or party responsible and insurance pays some on behalf of the patient. When it covers the bill or most of it, it’s a blessing. And then there are times like these.

When you visit a medical practice these days one of the initial forms they ask you to sign is a financial responsibility form. That form says you will be responsible for paying the entire cost of the visit and generally the provider will bill your insurance company as a convenience for you.

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Unless the provider accepts assignment, where they accept the amount the insurance company approves for the visit as their full payment due, you will be responsible for the rest no matter how much the bill is.

If you did sign the financial responsibility form and accepted the payment for services then it seems your options to investigate are to carefully examine the itemized bill and confirm the services you are being billed for were actually performed.

Second, you can contact the billing office of the medical provider and confirm those are the legitimate charges for the services provided, to make sure they did not bill you an incorrect amount.

Third, you can ask the financial office if they have some policy for reducing the bill based on financial need.

Fourth, you can contact your insurance company and ask them if the amounts you were charged for the services provided are the usual and customary charges for such services in your area. Generally, insurance companies have fairly good coverage for urgent care appointments so I suspect the bulk of your bill was not for the visit itself.

Please post your responses and follow-up messages to me on this in the comments section below.

Sincerely,


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Steve Rhode is the Get Out of Debt Guy and has been helping good people with bad debt problems since 1994. You can learn more about Steve, here.
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4 thoughts on “Urgent Care Wants Nearly a Thousand Dollars for a Visit! – Diane”

  1. This health issure is a money issue no doubt. So I know you have looked at your daughter’s lifestyle-food and exercise. Have you looked into alternative treatments for your child. Changes in food, vitamin therapy, accupunture, etc. Use a blender to get lots of good raw food-fruit and vegetables in a great drink if she does not like to eat them. I know you love and care about her very much. Our family’s thoughts and prayers are with you

    Reply
  2. Hi Steve – Diane here. THANK YOU so much for responding to our question!! To update you: we reviewed your points above and searched for the paperwork you mentioned (which we couldn’t find) and then finally had the courage (and calmness) to call per your suggestions. First we called insurance and we compared bills over the phone. In short, the urgent care has only submitted about 1/3 of the charges/services to the insurance that they had listed on our long bill and insurance had paid for all of them minus $50.00. So we called the urgent care billing and after a bit of time they (not exactly admitted to the above) but said that the second part of the bill was sent to insurance at a later time but they might not have received it yet. Why urgent care is sending the bill to insurance in pieces, I don’t know. Per urgent care, they send a bill to the customer immediately after hearing from insurance. Since insurance responded on the first round of charges, they then automatically send us a bill – which here included everything. We pointed out that the bill said it was “final” and that insurance has responded in final. Insurance assured us that from what we shared, in the end we may only have to pay between $50.00 to $100.00. So for now we sit tight for one week and then call again.

    Reply
    • Diane,

      Great news. Always nice to have the common administrative process issue instead of a big surprise.

      Probably a good wake up though to not be afraid to ask the treatment center what the expected charges will be and how much insurance normally covers. Nobody likes the big bill surprise.

      Happy Holidays.

      Steve

      Reply
  3. Hell, I would lodge a complaint with the doctor that suggested that the child be taken to the Emergency Room affiliated with the Hospital that the doctor works at…

    It seems like some collusion going on or at the very least, something smells rotten…

    Reply

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