High charge at urgent care

[u/PromotionAgile]

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?

[u/Sassycats22]

This is why I don’t go to urgent care or the ER unless it’s an absolute emergency. Prices are outrageous.

[u/PromotionAgile → u/Sassycats22]

It's almost cheaper to fly to Mexico and visit a pharmacy there

[u/Berchanhimez → u/PromotionAgile]

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.

[u/External_Soil5620 → u/Berchanhimez]

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.