r/HealthInsurance • u/PromotionAgile • 9d ago
Plan Benefits High charge at urgent care
I was charged $900 for a 15 minute visit to urgent care. Insurance doesn't cover any of it because I have a high deductible plan. I called the medical practice saying the charge was ridiculous. They checked the billing codes and found no error.
They said the insurance company sets the price and I can file a grievance with insurance. That seems like a wild goose chase.
Why is it so expensive? Is there anything I can do to reduce the cost?
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u/LizzieMac123 Moderator 9d ago
If your EOB from insurance says your fee is $900, that's the fee.
Urgent Cares are more expensive than a PCP/specialist but less expensive than an ER.
A provider doesn't always have to charge you the full amount from the EOB, but they are entitied to. My last urgent care visit on an HDHP plan was about $700 and it literally involved them telling me to go to the ER, they couldn't treat what I had.
There is no magic way to reduce the cost if it was coded correctly-asking for a detailed bill only works if something is wrong (wrong charges, charged twice for something that only happened once, etc.) You can always try to negotiate, but it's up to the provider as to if they are willing to negotiate. Most providers offer payment plans too. But none of us would be able to tell you if your provider does any of that, you'll just have to call and ask. Asking for a paid in full discount sometimes works too... "if I offered to pay you $500 now to settle this, would you consider that" of course, that means being able to then pay that agreed-upon amount right then.
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u/LordGrantham31 4d ago
What ended up happening with your urgent care bill since they simply asked you to go to ER? You just paid it?
Asking bc I had a somewhat similar experience. Had a shoulder dislocation, went to an urgent care and AFTER taking X rays, they said they didn’t have any pain meds and I would have to go to ER. Felt a little scummy tbh since if they were going to ask me to go to ER, why bother taking the X rays. Also what kinda urgent care doesn’t stock pain meds.
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u/MikeUsesNotion 9d ago
Sounds like it was covered. Covered doesn't mean you pay nothing.
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u/PromotionAgile 8d ago
In that sense, sure. But that wasn't really my point.
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u/NSBJenni 8d ago
I also have a high deductible plan and pay a similar fortune when I go to urgent care. It sucks - and good luck to you
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u/MikeUsesNotion 8d ago
Saying it wasn't covered when it was really changes what you're saying.
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u/PromotionAgile 8d ago
I was covered by insurance. My question essentially concerns the amount I am being charged. Was that not clear?
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u/throwawayeverynight 7d ago
Your point is… Your responsibility is $900 because you gave a high deductible. You feel that a 15 minute visit should be less. Here’s the thing it’s a urgent care, charges are more expensive. You could potentially ask to see if you where to pay as a self pay patient how much would it be. Keep in mind that the claim submitted to insurance would be reversed and cancel, it’s illegal to have 900 applied to your deductible if this isn’t the amount they will collect. High deductible plans are really there to have your back if something major happens, it’s extremely expensive just for just office visits if you truly don’t go often to a Dr
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u/MissionEnvironment34 9d ago
They can charge whatever they want, but what is the insurance’s allowable for those codes? They can charge several hundred, but the insurance company has an allowable amount for each of those codes. Have you received an eob from your insurance - or is this just what the urgent care is telling you? Call your insurance company customer service phone number and ask them for help explaining how much you owe the urgent care.
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u/positivelycat 9d ago
Fighting it with anyone is a wild goose chase. Insurance and the provider agreed upon the rate long ago. Neither will budge. You can't fight your benefits and the provider typically won't budge after insurance processes. It is what it is
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u/Old_Draft_5288 9d ago
Assuming this urgent care was in network, look at your explanation of benefits.
Ultimately, though, your deductible is your responsibility.
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u/Mysterious_Luck4674 8d ago
Your insurance did “cover” it of the $900 goes towards your deductible. That’s how a high deductible plan works - you pay the entire cost until you meet the deductible. Then you pay much much less.
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u/Concerned-23 9d ago
It’s an urgent care office visit. It’s going to be expensive.
Also your insurance does cover as they adjust to the allowed amount
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u/Initial_Freedom7981 9d ago
You owe all your costs until you meet your deductible. That’s how insurance works. You can ask to do self pay, not insurance, and it may be less.
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u/PopularPrompt2892 8d ago
This. I didn't have an HDHP at the time, but I had Medicaid, and the urgent care was not an enrolled provider. I looked up the average amount received for the service I was billed for (in my case it was a CT scan), which was $400. They had billed me $800, so.I went through this will a billing specialist supervisor there and basically reasoned that this is all they would have gotten from me had I been insured through one they accept, couldn't afford the $800, and could they settle it for $400. She agreed, happy to receive a payment, I got it in writing, and that was it. I probably got lucky, but it's always worth a shot, if you're willing to exhaust the energy.
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u/Time-Understanding39 8d ago
My When you go to urgent care or the ER, you’re not just paying for the few minutes you spend with a doctor. You’re paying for the whole setup that’s ready in case something serious happens.
That means: • Special equipment (X-rays, labs, heart monitorsuyu, etc.) that has to be bought and maintained even if you don’t use it. • Specially trained staff (doctors, nurses, techs) available 24/7 who can handle anything from a broken bone to a heart attack. • The ability to treat emergencies right away, which is more expensive to keep running than a regular clinic.
So the bill covers the constant readiness and resources, not just the 15 minutes you were seen.
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u/Naive-Garlic2021 8d ago
Unless a mistake was made, this is an expensive lesson, one that many of us have learned the same way. Always ask beforehand what the cost will be. Download a copy of your plan coverage and study it carefully. Mine specifies that if I go to an in network urgent care, it's 40 bucks. If you have a high deductible plan that pays nothing until you meet the deductible, and you don't expect to meet the deductible, it may be better to just pay cash. If you want better coverage and have a choice, you'll be able to switch for next year. But you'll pay a higher premium, likely more than 700 bucks over the year.
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u/Sassycats22 8d ago
This is why I don’t go to urgent care or the ER unless it’s an absolute emergency. Prices are outrageous.
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u/PromotionAgile 8d ago
It's almost cheaper to fly to Mexico and visit a pharmacy there
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u/Berchanhimez PharmD - Pharmacist 8d ago
I didn't see anyone saying this so apologies if it's already been said... but the reasons ERs and urgent cares are as expensive as they are is that you aren't just paying for the 15 minutes the doctor saw you.
You're paying for a lot of other things. For example, an ER at a level 1 trauma center generally has to have multiple teams of trauma-trained surgeons, anesthesiologists, and ER doctors onsite 24/7/365 - but the minimum is one onsite and one on short call (there ready to start operating within 15-30 minutes at the most). There's also a list of over a dozen specialty doctors (examples being ENT doctors, heart doctors, neurosurgeon, etc) that they must have onsite or on short call (can be in the ER ready to see a patient within 15-30 minutes at most) 24/7/365. If it's also a pediatric level 1 trauma center, then all of that is doubled because there must be pediatrics versions of all of that too. This is why there's only about 200 level 1 trauma centers in the whole US/Canada. Beyond just staffing, they need to have advanced imaging capability - such as MRI, CT, etc. 24/7/365 - which means having at least two of each so that if one has to go down for routine maintenance, or breaks unexpectedly, they still have one functional while they work on getting the other one back up. Then factor in the 24/7 staff coverage to respond to breakdowns (maintenance people) and to do that imaging (radiology, etc)... and it's extremely pricey.
As you go down the "levels" to level 2, and level 3, they don't necessarily need as much staffing onsite, but they do still need to have basics like x-ray capability, 24/7 emergency medicine trained doctors, etc. Basically any hospital of decent size will be a level 3 center at least. Level 4/5 are typically limited only to rural/backcountry hospitals. But this is why the ER is the most expensive place to get care. Because you aren't just paying for what you used, but also for the overhead cost of having all of that onsite/on-call in case you ended up needing them.
Now, urgent cares are almost never trauma centers. But many are 24/7 - so they still have to have at least one emergency trained physician on hand at any given time. Many also offer at least some onsite lab/imaging services, like x-ray, CT, MRI in some cases, and many blood/tissue tests on site. If the urgent care sees an average of 2 patients overnight, they still have to pay the doctor overnight.
This is why insurances are willing to accept higher rates for the "same" codes from an urgent care - and higher still for an ER. Because the insurance knows it's not just paying for what you needed, but for the fact that they have anything that anyone could need.
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u/External_Soil5620 4d ago
And let’s not forget you are chipping in extra for those that come in with no insurance/poor insurance that doesn’t meet the costs for the ER to provide services/equipment.
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u/whatdoiknow75 8d ago
Have you seen the EOBm, is that 900 before or after it was submitted for insurance, and is the urgent care center a participating provide for you insurance?
Insurance companies don't set the rate, they negotiate a rate for each of the procedure codes, usually significantly below fhe providers’ rates. That does your provider say is the appoved fee.
An yes, having a high deductible plan stinks, particularly if you don't have an HSA or FSA to cover the deductible.
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u/QuietNervous4891 8d ago
Did the bill show a breakdown of the different rates? Should show the “sucker” price, negotiated price, allowed, not allowed etc. Atleast for me it comes on a separate letter from my insurance and will show how much I owe the provider.
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u/Actual-Government96 9d ago
The insurance company would happily pay them less if they agreed to it, but unfortunately, they haven't, so the insurer must use the agreed to contracted rate.
The billing office is just pointing you back at the insurer because they can, insurers make a fantastic scapegoat in these scenarios.
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u/buzzybody21 8d ago
It’s likely that much because you have a high deductible plan, and you haven’t met your annual deductible yet.
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u/FollowtheYBRoad 8d ago
Without knowing what your appointment was for, it's hard to say. Yes, for that amount of time, it does seem high, but again, we don't know what was done. (I'm not sure why people seem to normalize the high cost of these short visits.) You can try and set up a payment plan.
I dislike the high deductible plans (have one myself). If your HDHP plan has an HSA, suggest putting money aside in the HSA to help cover the medical bills. Or, at the very least, have money set aside in a savings account somewhere that is equivalent to amount of your deductible.
The HDHPs are part of the reason why people probably don't go to the doctor that often. It's just too expensive for people to come up with/meet the high deductible amount.
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u/tre91396 8d ago
Why do you dislike HDHP plans ? Do you not like to take advantage of the single best tax benefit there is in the US tax law?
You can pay a higher premium to the insurance company for a lower deductible and the insurance company keeps all that money.
Or you can pay yourself thru the HSA and you keep the money. Once you have enough in there to cover your deductible, the deductible stops mattering.
The only thing to remember, is in either case, you are paying roughly the same amount. The only difference is who has the ability/opportunity to keep that money you are paying either way.
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u/FollowtheYBRoad 8d ago
I pay an extremely high premium of over $1,500 per month for myself with a very high deductible of over $7,000 for an ACA bronze marketplace plan. If I were 20 years old and didn't go to the doctor very often, I would definitely do an HSA. That's what I've recommended to our college-age children.
We had an HSA as older parents of four kids back when we were in the workforce. We could never make it work. Every one in the family was either at the dentist, doctor, or eye doctor. We just could never save enough in it to make it work for us financially.
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u/tre91396 8d ago
That is certainly extremely high! Couldn’t imagine what the premium on the “low” deductible plan would be for you.
If it’s 2,100 a month, the higher premium is basically equal to the deductible of the HDHP.
That’s my point, one way or the other, you are paying the same amount. Only difference is who you pay it to.
Either way, I understand your feelings!
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u/OrganicBoysenberry52 8d ago
Always look at your EOB. I went to urgent care earlier this year and was tested for flu and rsv plus a lung xray to check for pneumonia and it was 750. Every test and image adds to the price.
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u/DomesticPlantLover 8d ago
It's expensive because of all the things they have to be able to deal with. It's a lot lower level than an ER. Both in terms of cost and of things they can do, but there's still a lot. There are tons of people who have to be paid out of that visit: the provider, the person/people that check you in and out, the CMA that did you intake, the person that files your insurance, the person that cleans it, the person that does the charts, the people that do the tech support, the cost of the medical records system, etc. They almost certainly have the ability to do x-rays. You may have not needed it, but it still has to be paid for. And the person that is there to take the x-rays. There's lab tests they have to do.
You aren't just paying for the few things you personally needed, but for the ability to have access to it when you need it. It's like an ambulance. You might never need one, but they have to be paid for 24/7 used or not. They have to have drugs that treat lots of thing--often that expire never used. But they need them all the time for the one time it's needed.
In other words, you are paying for the convenience and the security have easy access to care and makes uour live far better and maybe even saves it.
Not saying it's a great system, just saying that's how it works.
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u/Botasoda102 9d ago
Whatever insurance allows goes to your deductible and what you owe. If it was just and office visit with no procedures, injections, etc., I bet you will owe $200 to $300 max. Don’t worry about what they charged until insurance adjudicates the claim.
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u/IntelligentChard1261 9d ago
I remember paying 145$ for a urine assessment I could have probably ordered at home. Then the office and on and on. $600 later
Please make voting choices with healthcare in mind. America healthcare is broken. It's awful that one Ed visit can be crippling.
You owe for your visit. Stop asking the emergency plumber why he's so expensive.
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u/Cynidaria 8d ago
Support single payer, Medicare for all type health insurance. Even most Democrats were working towards systems that continued utilizing health insurance companies and the health insurance companies are 85% of what's wrong with US Healthcare and what makes it unaffordable. And the insurance companies generously fund every politician who will take their money. Support the outliers. You can find them by following someone fingerpointing and screaming "socialist!".
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u/Share_Sure 8d ago
HELL YES - Health care in America is just another industry. No other modern country thinks medical care is just another profit center, just another car repair shop.
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u/Unholy4Guacamole 8d ago
In the future, ask for upfront billing costs/estimates. If your insurance deductible is too high, ask the office how much for a cash-paying rate (not billing insurance).
Additionally, depending on your medical needs, maybe reconsider your health insurance plan. If you don't go to a doctor regularly, maybe you don't need to pay high monthly premiums for a lower deductible.
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u/Necessary-Wind3265 6d ago
That’s a terrible insurance plan. Most ACA marketplace plans charge you a $75-$100 copay for an urgent care visit
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u/Alaskadan1a 5d ago
Urgent cares are set up to provide convenience, but at an extra cost. As noted by others, they charge more but see walk-in appointments. ERs are worse, and you could think of it as saving $2000 bucks by not going to the ER.
Most issues UC deal with can also be dealt with at your primary care office. If you can get a same-day appointment, you might say 500 bucks.
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u/Safe_Conference5651 5d ago
I went into an urgent care because of a breathing problem. I could not lay down. They immediatly sent me to emergency. I spent about a week in the hospital, mostly in ICU for the collapsed lung, yet that 2 min at urgent care was the largest bill in that ordeal.
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u/External_Soil5620 4d ago
That’s not unusual - my 2 hr ER visit was 10,000$ and I was responsible for 900$. Had to pay it.
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u/Sufficient-Wolf-1818 8d ago
Face time of 15 minutes may be only part of the picture. Were there any lab tests? X-rays?
A PCP visit tends to be less expensive than urgent care, but even there I am seeing about $600 for a visit with 10 min face to face. Plus, booking an appointment is weeks or months out with my pcp.
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8d ago edited 8d ago
[deleted]
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u/PromotionAgile 8d ago
It's probably that the plan I signed up for has expensive contracted rates. I need to take a closer look.
No other tests
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u/Longjumping-Ear-9237 8d ago
Urgent care is usually the same cost as a same day office visit. I am surprised at the cost.
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u/ScarInternational161 8d ago
This is why asking for uninsured cash price can mean 100s of dollars. I realize it goes toward your deductible, but the urgent care here charges 150 for cash pay and 900 for insured. And we wonder why insurance is so expensive....
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u/AlternativeZone5089 8d ago
The time to haggle is before you've received the service. You have two options. One is to tell them you don't have insurance and want to pay cash. Then you ask the cost for being assessed/evaluated beforehand. You do the same thing before receiving any imaging/treatment. Ask the cost before each component. If you want to use your insurance then you do the same thing, but you'll need to call your insurance company with the CPT code for each component and ask what your cost will be, because if using your insurance then your negotiated discount, deductible status, and plan design comes into play and the UC can't tell you these things.
In ansswer to your question, it's expensive because UCs are staffed even when no one is using them, and they are staffed by people with a lot of expensive training.
I think it is a truism for many people that they consider what they pay others "ridiculously" (high) and what they are paid for their services "ridiculously" (low).
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u/nursetrixie00 8d ago
if you can afford it ask them for the cash price, many facilities will decrease the total cost if you will pay cash.
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u/Odd_Assistant_2782 8d ago
Blame your insurance not the urgent care !!!!
They agreed to those rates and approved passing them on to you !
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u/fleurgirl123 4d ago
Well, and it’s the insurance you have. If you don’t like the high deductible policy, pay more for something that is more generous.
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u/Tater-Sprout 8d ago
I don’t think the health insurance company sets the INITIAL price. The hospital sets the insane initial price. The health insurance company negotiates it from there.
Let’s be incredibly clear here:
The criminals in this entire system are the hospitals themselves. That’s where the absolute shit storm of insanity pricing begins.
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u/Accomplished_Boat499 9d ago
Google the billing codes and see if they match up to what you had done.
$900 for a 15 minute visit does not sound right. Urgent care pricing is more in line with PCP pricing, unless the urgent care is attached to a hospital and it’s billed at ER level.
Did you have any tests done?
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u/PromotionAgile 8d ago
No tests done. I think it's a matter of getting billed at the high deductible plan rate vs a different plan rate vs no insurance rate.
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u/Accomplished_Boat499 8d ago
Not sure why the downvotes on the first comment… but
A high deductible plan still has the same network discount as a non high deductible plan, provided they are on the same network. What differs between plans is what you pay v insurance pays on that discounted rate.
I would really investigate further, if that is truly the cost after discount for an urgent care evaluation, that’s a horrible plan - no matter your benefits.
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