r/HealthInsurance • u/Pretty_Day_9157 • Jul 30 '25
Claims/Providers Referred to ER from Urgent Care, surprise bill.
My 7 year old son was hit with a rock in his temple at a local playground. There was lots of blood, but overall a pretty minor injury. We went to urgent care to have it checked out, get stitches if necessary, and have professional give us an all-clear on a possible concussion. (I had just taken the CDC course a few weeks prior, no visible signs of one)
Urgent Care saw us pretty quickly and was able to clean my son up. At this point he was no longer bleeding, and the gash was pretty small considering the large amount of blood. The nurse on duty told us we should take an X-Ray, not really sure why. After this recommendation, they refused to do any further work on him or give him a stitch. There was no doctor on duty at the moment, not sure if that has anything to do with this. They call a local ER company and away we go, now wondering if it's necessary to even show up.
At the ER, we are told about incompetence of Urgent Care workers and "We would never XRay for this type of injury, but we could do a CT scan. Although we don't recommend it for a child!" All in all, a very weird interaction with the doctor but that's fine. We attempted to ask about billing, only to be told they will bill our insurance and get a bill later for the balance. The doctor at this point decided to numb the cut, wait 45 minutes, then apply a single stitch. This could have been a band-aid at this point. It really no longer felt necessary.
Three months later, bills have finally come in. My insurance provider is UHC, which I get through my company. I pay for the highest-tier plan just to avoid surprise bills.
Urgent Care, $75
ER Doctor, $1,141. Insurance plan discount $859, I owe $282.
ER Facility, $7,072. Insurance plan discount $5,432, I owe $1,600
Feeling a bit overwhelmed as I attempted to go about this in the correct way. My impression was that I go to an ER, pay $250, and I'm done. But now I see I owe the first $3,000 annually. Is there not a way to get insurance to pay this out since I went to Urgent Care first and got a referral? Are there any ways to reduce this bill? Really appreciate the feedback!
EDIT: I appreciate everyone's feedback. I've gone through it and it feels like I'm just going to have to absorb the cost. I'm 40 with three kids, this is the first time I've ever had to go through emergency care with anyone. Lessons learned. Thanks for the education, once again it's appreciated.
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u/chickenmcdiddle Moderator Jul 30 '25
So the ER copay is effectively the price to be seen at the ER. Because there were additional services rendered, these generated procedure codes and charges.
For almost every type of insurance you can access, you can almost assume that your plan will only begin to cover charges once the deductible has been met. Being referred to the ER doesn't really change your cost sharing responsibilities (deductible, coinsurance / copays) each year.
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u/LizzieMac123 Moderator Jul 30 '25
This- just like a PCP copay covers being seen, having vitals taken, and calling in an Rx--- anything else they do in office (bloodwork, imaging, an in-office procedure to dress a wound) that is all allowable to be billed separately and is subject to your plan's provisions.
The copay is like the "cover charge" at a night club or concert--- and then any extra services (bloodwork, imaging, procedures) are extra like if you order food/drinks or if you purchase merchandise from the band.
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u/murse_joe Jul 30 '25
True but it still sucks to get a ticket to an amusement park and then later on figure out they were billing you for every roller coaster you ride.
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u/IamTalking Jul 31 '25
Meh it’s like paying admission to a fair and then having to pay to go on every ride
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u/LizzieMac123 Moderator Jul 30 '25
I agree---which is why one should read their policy, at least give it a once over. Or ask the questions to you HR/during your open enrollment meetings if you are offered them. You don't walk into disneyland thinking your entrace ticket gets you access everywhere (all the meet and greets, the salon dress up for the kids, all the merch you want, etc.) and all of your food/drinks included. You do a lot of research when you plan your visit.
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u/murse_joe Jul 31 '25
Their kid was hit in the head and bleeding.
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u/LizzieMac123 Moderator Jul 31 '25
I agree that it's very unfortunate circumstances and my heart DOES go out to them and everyone- I wish they taught this in school and I wish it was less confusing... I wish pricing was more transparent and it was easy to say "I need this service, which doctor is in network with the least expensive price" and you'd be given a chart. ...but the reality is that it is not- it has not been easy for a long time- so learning your policy is the only way to combat that.
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u/StayJaded Jul 31 '25
You should understand your deductible, copay obligations, and other basic points of your plan when you make the selection during enrollment. The bad of coverage and deductible are outlined during the enrollment process that happens every year.
Understanding all of that is basic adult responsibilities.
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u/HOSTfromaGhost Jul 31 '25
…and the accumulation structure for the deductible can vary by plan as well.
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u/ugadawgs98 Jul 30 '25
No....you have a deductible and they are cerainly not going to waive it. That is the plan you pay for.
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u/10049j Jul 31 '25
Most providers actually have in their contracts that they are not allowed to waive the deductible
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u/SnarkyPickles Jul 30 '25
If your deductible hasn’t been met, you are responsible for the bills. It doesn’t matter if urgent care “referred you”, and you always have the right to decline care or interventions
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u/Educational-Gap-3390 Jul 30 '25
So here’s the deal. You went to urgent care and your son was seen. They sent you to the ER because that’s what urgent care does when it’s anything other than basic medical care and your son was treated there as well. Regardless of your feelings about treatment you still have to pay both facilities.
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u/Proud_Trainer_1234 Jul 30 '25
Any head injury requires an evaluation beyond the scope of an Urgent Care facility. And an basic ER visit costs the same for administrative processing, a doctors evaluation and occupancy of an ER room. From there, all the additional treatment is added.
The UC had no way of diagnosing the severity of your child's injury particularly if there was no MD on the premises. They were correct in referring you to the ER. Be thankful his injury was not serious.
It's up to you, the insured, to understand the coverage and limitations of your insurance policies.
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u/SlickityClean Jul 31 '25
This isn’t entirely true. If the PECARN rule is negative, then he doesn’t need a CT, and therefore wouldn’t have had to go the ER. It’s fairly basic pediatric head trauma evaluation that most general practitioners should know.
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u/Proud_Trainer_1234 Jul 31 '25
The op said there was no MD on site which is common for Urgent Care. They are there for rudimentary diagnosis and stabilizing treatment only.
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u/Pink-Jalapenos Jul 31 '25
Absolutely not common. Maybe if you are in a state where PAs or NPs can work without supervision but I’ve always seen a doctor at an urgent care
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u/New_Milk6069 Jul 31 '25
At all the urgent cares in my city there are only NPs. They're technically writing orders under a doctor but he's not physically there in the clinic. Very common these days.
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u/Proud_Trainer_1234 Jul 31 '25
The last few times I've visited an UC there were no Doctor's on the premises. l
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u/golfer9909 Jul 31 '25
Possible reason why urgent care sent you to ER is the location of the cut. The temporal artery is pretty vital. I lost a nephew from a temporal artery injury
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u/cwill498 Jul 30 '25
You have to meet your deductible which is why you owe the funds for the facility and physician. Once the deductible is met you would only have to pay the ER copay. Luckily they are not billing you for that in addition to your deductible balances.
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u/Berchanhimez PharmD - Pharmacist Jul 30 '25
No. Your plan is correctly applying your deductible. Having a referral doesn’t change your plan’s coverage details to not have that deductible anymore.
I’m honestly surprised though if a $3000 deductible plan is the “highest tier” your company offers, because that’s still considered a high deductible health plan (if that’s the individual deductible). Some companies do only offer high deductible plans, but in that case you do qualify for an HSA which allows you to take pay pre-tax (no federal income tax on it) up to a certain amount and set it aside for healthcare costs. So if it really is a $3000 deductible per person, you may want to look into setting one of those up.
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u/nutella47 Jul 30 '25
It could be a family deductible. My plan would be $1750 for just me, but it's $3500 when I switched to adding my family.
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u/Evamione Jul 30 '25
I am not surprised by this. I have seen many companies where the $3000 deductible is the low tier, $5000 is the mid tier and $6500 is the high.
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u/chickenmcdiddle Moderator Jul 30 '25
It's only an HDHP if it meets certain IRS criteria. Because OP has copays involved, it's almost certainly not an HSHP / HSA-eligible plan. Actual HDHPs have no first-dollar benefits until the deductible is met (less preventive care)!
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u/Berchanhimez PharmD - Pharmacist Jul 30 '25
Ah, thanks, forgot about that stipulation too. But still kind of surprising that a $3k deductible is the best plan offered.
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u/Berchanhimez PharmD - Pharmacist Jul 30 '25
No. Your plan is correctly applying your deductible. Having a referral doesn’t change your plan’s coverage details to not have that deductible anymore.
I’m honestly surprised though if a $3000 deductible plan is the “highest tier” your company offers, because that’s still considered a high deductible health plan (if that’s the individual deductible). Some companies do only offer high deductible plans, but in that case you do qualify for an HSA which allows you to take pay pre-tax (no federal income tax on it) up to a certain amount and set it aside for healthcare costs. So if it really is a $3000 deductible per person, you may want to look into setting one of those up.
Edit: it’s probably not a true HDHP because of the $75 copay for urgent care, which is annoying because that means you’re not eligible for an HSA.
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u/dscrive Jul 30 '25
After surprise gallbladder surgery with an overnight stay and (still) waiting months for bills to settle so I know how much I really owe the hospital in addition to all the money I've already spent. . .I've decided that I am switching to the not high deductible plan next year but I'm rather miffed that I can't keep contributing to an HSA
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u/RedChairBlueChair123 Aug 01 '25
Once you have the account you can keep adding to it.
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u/GTAIVisbest 25d ago
Errrr.... You can only contribute to an HSA if you have an HDHP?? Or am I missing something
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Jul 30 '25
[removed] — view removed comment
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u/xylite01 Jul 31 '25
I'm all for bringing light to the problems in healthcare... but there aren't actually more people working for insurance companies than healthcare providers. Not even close. This case also was not a denial. OP had a deductible and needed help understanding cost share benefits. It doesn't do anyone any favors to use incorrect information. Positive discourse and change has a much better chance when we stick to facts.
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u/peskywabbit1968 Jul 31 '25
You've done very well so far with 3 kids and 40 years old if you never had to go the ER. I call that a win.
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u/Actual-Government96 Jul 31 '25
The ER piece is legit. Honestly, though, if there was no one licensed to treat a head injury at UC, wtf didn't they turn you away to begin with??
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u/Nowaker Jul 31 '25 edited Aug 01 '25
Do urgent cares really have doctors to treat head injuries? That sounds like an ER thing to me, not a UC. I'm seeing UCs as the place that requires no appointments, has more extended opening hours (but not 24/7), has a stash of various immunoassays, and basic equipment like x-ray (that primary care usually don't) to make good calls on further steps. I visited three different UCs - in my rural area, in Austin, TX, and in Midtown NYC, and they were very similar and matched the criteria I mentioned.
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u/Not_High_Maintenance Jul 31 '25
I am a nurse at an UC. Most head injuries, ESPECIALLY children, will not be treated at an UC. We do not have MRI machines, and therefore, not fully equipped to treat head injuries. The X-ray was to check for debris left in the wound.
What would have happened if your child was treated at the UC and then started having seizures? That’s a huge liability!
Urgently Care did the correct thing.
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u/aprettylittlebird Aug 01 '25
There’s a lot of incorrect statements here. Many head injuries are completely fine to be managed in the urgent care setting. This is something I do all the time and my partner as well (both acute care docs at different urgent care settings). Also, you wouldn’t MRI a head injury but you may need to CT one depending on the severity of the mechanism (this is not super common, most head bonks are pretty minor). Finally, you don’t need a xray to check for debris in the wound, you can just look at it with your eyeballs 👀
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u/Actual-Government96 Jul 31 '25
They should absolutely be able to do stitches, and at least examine the patient to determine if scans are needed. I spent 5 hours in the ER last year with someone concussed, the Dr didn't order any xrays/scans based off the initial exam. The UC Dr should be able to perform that exam. If not, they had no business even seeing the patient for a head injury.
I'm pretty baffled as to how they would even bill an office visit with no Dr, unless by "nurse" op meant nurse practitioner.
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u/Not_High_Maintenance Jul 31 '25 edited Jul 31 '25
Urgent Care will not treat (stitches) if they refer you to the ED. There are three reasons for this:
If treated in UC, most patients will not follow up at the ED.
It is the preference of the ED (hospitals) that we work with to not treat just in case it all has to be undone and then redone. We will clean up the wound but not stitch.
Facial stitches should be performed by a plastic surgeon, especially in children.
OP’s child’s would must have been serious enough that the UC called EMS.
EDIT: Added #3
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u/Actual-Government96 Jul 31 '25
Interesting, the stitches make sense in that scenario.
But in the OP, the child was cleaned up by a nurse and sent to the ER without seeing a Dr.
Why would UC even intake/triage the patient if they weren't going to do an exam? I understand doing an exam and recommending they go to the ED for scan/treatment, but it doesn't sound like that even happened?
I also didn't read where EMS was involved, although it's possible my reading comprehension is just exceptionally poor today.
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u/Not_High_Maintenance Jul 31 '25
It was probably a nurse practitioner or a physician assistant. Many UC’s are rarely staffed with MDs or DOs nowadays.
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u/Not_High_Maintenance Jul 31 '25
“They called a local ER company and away we go”. I took this to mean an ambulance company. I could be wrong.
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u/Not_High_Maintenance Jul 31 '25
Front desk is not staffed by anyone who can triage, so there is no way of knowing the condition of the patient until they are seen in the back by a medical professional.
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u/catachip Jul 31 '25
In response to your edit… I think you fundamentally don’t understand how insurance works. It’s not about it being emergency care. It’s about you having a $3000 deductible. Any care could have to be paid up to that amount first. If you want a lower deductible, you will need to pay a higher monthly premium.
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u/SmallHeath555 Jul 31 '25
In the past you likely would have paid your copay and that would be it. Most plans now have deductibles and coinsurance which makes copays irrelevant. You have no idea what things will cost and doctors/hospitals and insurance are now both pushing most of the inflated costs to customers who are never told the fees and have no recourse to dispute them. It’s awful but the lobbies for hospitals and insurance companies own washington so not much we can do.
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u/badger_badger_ Jul 30 '25
Good grief. I don’t know how many commenters need to tell you the same thing.
Look into whether the hospital or health system offers financial assistance. Typically it’s not advertised but it’s there. I don’t qualify for any other sort of assistance (WIC, HEAP etc) but I was still able to get my bills reduced by 40%, the income guidelines might be higher than you think.
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u/disneyluver1234 28d ago
Yes this!! My family also does not qualify for any sort of government related assistance. My child just had surgery last week and we were going to get a pretty hefty amount of medical bills sent our way (our deductible of course) so I applied for the hospitals financial assistance program and was approved for 100% assistance. All current balances already on the account were immediately waived and all future ones from the surgery/post op will be covered as well :)
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u/Jujulabee Jul 30 '25
What exactly is the benefit for an ER visit.
You mention a co-payment of $250 but you don't seem to have been billed for that.
While agree that additional services are not covered by the co-pay, I don't see where you were charged a co-pay or why you were charged a facility fee - was in lieu of a co-payment or in addition to a co-payment.
Sometimes there is some verbiage in which it is more expensive if you are NOT admitted to the hospital.
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u/Individual_Zebra_648 Jul 30 '25
They weren’t billed for a $250 co-pay because they haven’t paid their $3000 deductible for the year yet. How do so many people not understand this concept or their own plan?
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u/laurazhobson Moderator Jul 31 '25
There are all kinds of benefits in terms of structure.
Some of them have a co-payment WITHOUT a deductible which essentially pays for you to be checked into an ER but if you had procedures or tests, those would be additional and subject to the deductible.
Co-payments are generally in lieu of the deductible as they apply to "visits" For example a co-payment for a specialist could be $75 but lab tests are in additional fee and covered according to one's deductible.
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u/Individual_Zebra_648 Jul 31 '25
Uh yes I am aware of this. Not sure why you felt the need to state this. Of course there ARE plans that have a co-pay without a deductible but OP already stated that is not their plan. None of this applies to the post. OP stated they DO have a $3000 deductible that they haven’t met yet hence they weren’t charged a $250 co-pay.
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u/StayJaded Jul 31 '25
Every plan I’ve had over the last 25+ years has had both copays and a deductible. Once the deductible is met the you only pay the copays, but until that happens you pay both.
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u/laurazhobson Moderator Jul 31 '25
Of course there often deductibles when one has co-payments but the point is that the co-payment buys your place in the examination room and you aren't paying additionally for that.
The deductible is used to cover those charges which are not part of the office visit - tests, facility charges and equivalent.
Some plans only have co-insurance and a deductible and that is different as you will pay co-insurance for even an office visit without tests and might have to pay the total until your deductible is met. So that is typically pay in full until deductible is met - then co-insurance until you meet your annual out of pocket cap.
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u/PartyHorse17610 Jul 30 '25
Agreed I would want to see the itemized bills to make sure the co-pay is being properly applied.
I’m also a little confused by the ER facility entry is that a facility fee?
OP should thoroughly consult their EOB statement for each bill.
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u/MrPBH Jul 30 '25
The facility fee is what the hospital charges for you accessing their ER to seek medical care. It's part of their cut. They can also charge for nursing services, labs, imaging, medications. You get hit with a facility fee just for signing into the ER.
The professional fee is what you pay for the doctor's assessment and treatment.
Usually the emergency doctor is not a hospital employee, but rather a contractor for the hospital. They work for a physician group who holds the contract to provide services to the hospital's emergency patients. Thus, they bill insurance separately and you get at least two different bills from each emergency visit.
I say "at least" because you can get separate bills from other specialists who are consulted on your care, bills from the radiologist for professional fees for reading your images, and bills from the ambulance company that transported you to the emergency department.
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u/krysteline Jul 30 '25
Do you have an ER copay of $250? Or just an urgent care copay of $75? If you have an ER copay, you probably shouldnt be getting charged for the ER visit procedures, but if you do then its all going to go against your deductible til its met.
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u/Unable_Pie_6393 Jul 30 '25
I recently found myself in a very similar situation. $200 ER Copay. My insurance plan literature states that Emergency Services are NOT subject to deductible. So, I thought : $200 copay & I am good...
Turns out, what that copay covers is EXTREMELY limited. Basically, the second you see a doctor you get hit with physicians fees, which ARE subject to the deducible. Even though it is an emergency service.
I could not get anyone at the hospital, insurance company (Cigna), or on Reddit explain it to me in a way that makes sense to me.
At any rate, my $200 Copay was that plus $1025 (for physicians fees subject to my $750 deducible then 20% coinsurance ).
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u/paigicus Jul 31 '25
I had a kidney stone in November and went through the ER and same. $250 copay not subject to the deductible, except I had to pay the ER doc, the hospitalist, the anesthesiologist, and the urologist. But it still saved be a ton of money on the diagnostics, faculty fee and surgery costs.
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u/Few-Ad-1135 Jul 30 '25
It doesn’t help you now but check out accident insurance. I’ve just started a new roll and our insurance covers out of pocket insurance for accidents not covered by the health policy.
With my two boys that can’t walk and chew gum at the same time without getting head trauma, I wished I knew about this before!
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u/babecafe Jul 31 '25
The benefit to the insurance company for going to urgent care is much greater than it is for you, but they don't like to share benefits as much as they enjoy sharing costs. In a better world, they'd cover urgent care 100% to encourage its use over direct ER visits, and/or cover the ER better when urgent care refers you there.
IMHO urgent care shouldn't be charging when they merely triage you to an ER, but I'm sure the stans for urgent care would disagree. Everyone wants to be paid.
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u/Opposite_Trouble_282 Jul 31 '25
There’s a deductible and max out of pocket. You’re responsible for 100% of your deductible then you’re responsible for either a copay or co insurance until the max out of pocket is met. Unfortunately there’s no way around this. It’s important that you fully understand your benefits!
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u/Practical_Taste325 Jul 31 '25
Pay the money and be done with it. You know that you're responsible for that amount. There was no error. That's your plan.
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u/Nowaker Jul 31 '25
There is no surprise bill here. You went to that ER and received services.
What you could question is the facility charge. I'd start from asking for a full breakdown of everything that contributes to that charge. Search for anything billed and not provided.
You could also send someone incognito to inquire about pricing for similar services as provided to you to see if a quote provided to those who ask for it beforehand includes the same facility charge, or it magically disappears or decreases a ton because they see a client who shops around and doesn't blindly accept everything because "we accept your insurance, you're in network with us" nonsense.
It's worth noting that an ER tried billing my insurance $10K or so of facility charge but the insurance knocked it down to $0 paid to them and $0 paid by me.
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u/virrk Jul 31 '25
Two things.
First. Depending on exactly the plan you have you might only need to pay $250, but in other cases you haven't met your deductable. I have had plans where ER was $100 + 20% of services. Another plan ER is $150 no matter what, but if admitted to the hospital then I'm paying for a large percentage of that. You might need to ask who ever the manager is of the plan, probably the insurance brokerage or maybe HR.
Second this might be a case of balanced billing. Basically someone who saw you doesn't have an agreement with your insurance so the bill you for the balance of what insurance didn't cover. This can happen at an in network ERs. This is illegal in some states, and legal in others. It depends where you are. For example a California supreme court case made it illegal for ER or urgent care to balance bill you, but any other locations it's legal. A couple of states (can't remember which) passed a law explicitly making it illegal. Check local regulations, many times they will still bill you even if it is illegal and claim it was a "mistake".
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u/Weekly-Anything1573 Jul 31 '25
you’ll have to pay it, but you can pay it $10 a month if you need to. They shouldn’t make you have a payment that’s more than you can afford.
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u/brsboarder2 Aug 01 '25
You weren’t referred to the ER you decided to go after getting poor advice. Also, it was probably a nurse practitioner you saw, as an urgent care likely can’t be open without a practioner. There is almost always a deductible before insurance gets involved. They don’t care. The same thing would have happened if you went to the pediatrician and the pediatrician said go to the er.
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u/Islandgal87 Aug 02 '25
I always suggest that you request an itemized bill. I went to the ER once for a fractured ankle. The bill to the insurance was approx $3300. I was in and out in less than an hour. I wondered why it was so expensive. When I received my bill, it showed that I was charged for an IV but no medication. It showed they billed for a cast. I didn't have an IV, and it was too swollen for a cast.i was told that I would be to see an orthopedic specialist for follow up and they would probably put me in a cast. I asked the billing department to do a review and explained that I didn't have an IV nor a cast. After reviews, a corrected claim was sent to my insurance. The price dropped from $3300 to $1800. I had an ER co-pay plus a co-insur which was significantly lower after the claim was corrected and rebilled.
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u/sugarcookies1234 27d ago
Having two ER bills is normal. Some (all that I know, but some programs work diff) emergency medicine doctors are not employed by the hospital directly, they are part of a separate contracted physician group. So one bill is from their physician group billing you for their services/workup. The second ER bill from the hospital itself, is to cover general and combined costs of the patient’s acuity/triage, encountered staffing time (nurses, techs), medications, monitoring devices for blood pressure, heart rate, EKGs, monitoring of oxygen saturation, etc.. ). Also not so fun tip, but patients are assigned an emergency severity index score or ESI on presentation. Your acuity and pathway/triage/initial work up is based off of that, and regardless of the final outcome, you will be bill based off that acuity at a minimum. I hope this makes sense. I work in the emergency department, and I was caught off guard with the number of bills as well.
Ask for an itemized bill, so that you can see every charge.
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u/Visible-Strength5467 Jul 31 '25
Your post states, “a local ER company”. Does this mean not an ER associated with a major hospital? If so, I feel like these facilities are more like an ER-in-the-box where they take advantage of our screwed up healthcare delivery system in this country where transparency is not existent. I’m usually not a conspiracy person, but if this is a private ER not associated with a major hospital, the urgent care could be in cohorts with the referral in the remote possibility of gouging you and your insurance company hoping you have a low deductible. I will refrain from further speculation and advice until you answer my question.
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u/Pretty_Day_9157 Jul 31 '25
This is 100% what it felt like. There are plenty of other ER's in between the Urgent Care clinic and the ER with hospitals attached, but I got sent to the ER-in-the-box instead.
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u/Nowaker Jul 31 '25
You weren't sent there. You were given a recommendation and you followed it. You went there yourself even though there's plenty of other ERs in between. Unfortunately, you need to analyze everything in high stress situations too.
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u/Visible-Strength5467 Jul 31 '25
Wow, pass several true ERs to get referred to a so called ER who then fails to provide any upfront pricing or billing transparency? I don’t know how to define predatory any better. This should be against the law in my opinion.
Obviously never go to a ER in-the-box. I’ve gone to plenty of urgent cares that appear to provide real services but the one you went to does not appear to fit this category. They probably got a referral fee of some sort or owned by same company.
At this point you could either fight them for predatory billing practices (maybe a legal subreddit could offer some ideas) or simply educate yourself on medical debt collection practices. Personally, I would not pay this bill on principle alone, or I would offer to pay $5 a month. If the so called ER offered a reasonable fee for services performed, I would agree to pay that (ie. $500).
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u/Harrold_Potterson Jul 31 '25
Try applying for charity care/financial assistance at your hospital. Any hospital that receives ACA funding (which is pretty much all) is required to offer financial assistance for bills for patients up to like 200-400% of the poverty line. So even if you are middle class you could likely receive some level of discount.
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u/Wooden-Chocolate-511 Jul 30 '25
ER... nope... Urgent care call their complaint/grievance dept. STATE "You want to file a Formal Grievance on behalf of your minor child. That you want your bill waived due to their lack of care and unnecessary referral??? Explain what happened how you feel..... make sure to use the words formal grievance and for the bill waived. They have 14 business days to respond. If they don't call and complain about that too.
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u/UniversityAny755 Jul 31 '25
So I've actually had this happen. We went to Urgent Care, they said we can't help your child. You need to go to the ER to be seen for pneumonia and we were not billed for the urgent care. They did triage our child (temp and bp), and we talked to a doctor. We weren't just referred to the ER by the front desk. Maybe the doctor was kind and coded it in a way so we didn't have to pay the fee?
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u/Weak_Reports Jul 31 '25
You may have hit your deductible or out of pocket max already or the doctor just didn’t bill for the visit. They may have waived your copay or deductible, but that would be a violation of their insurance contract but does still happen.
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u/kumarcool423 Jul 30 '25
I assume you pay $250 when you get admitted in ER. Check your plan.
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u/RexCanisFL Jul 30 '25
$250 copay only applies after the $3000 deductible has been met for the year.
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u/MuttJunior Jul 30 '25
Is there not a way to get insurance to pay this out since I went to Urgent Care first and got a referral?
You might be able to find something like this. But the cost of the insurance is probably going to be much higher than your $3000 deductible you have now.
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