r/HealthInsurance • u/xact-bro • 29d ago
Claims/Providers Their website says they are an urgent care, the sign on their building said Urgent Care, the sign over the counter said Urgent Care, now they are billing as a doctor's visit and my health insurance won't cover it.
Earlier this year I dislocated my knee. Despite not being able to even stand up and having to be carried into a car, I did the right thing and I looked up my health insurance and they cover urgent care at 100%. I looked up physical therapists on my health insurance website and there was an Orthopedic Urgent Care in my city and in network! I went there, the building said urgent care on the side, it was a Sunday and the ONLY thing they offer on Sundays is urgent care per their website. They X ray me, confirm no tendons were torn, and send me home telling me to ice it and rest. A month later I receive a bill for well over $500. I look, my insurance paid out $12 and I was on the hook for the rest.
I called my insurance and they said it was because the PA I went to billed it as a doctors visit. I called the urgent care and they informed it its because according to the woman I spoke to, they are NOT an urgent care and do not bill as one. When I asked her how they could have "Urgent Care" on the side of their building, on their website, and on my health insurance's website she stopped talking and said I had to speak to a manager, then put me through to a voicemail, where the manager will not call back. I've tried several times and the same routine. The person on the voicemail who is only identified as "Bob" will not call back and does not have a phone number.
It's been several months of this. My company pays for a health advocate so I used them and they opened the case, told me it was billed correctly, no explanation, and closed the case. I called them and they said they called and were told that it is not an urgent care and that was that.
This is a major hospital in my city, its name is on the side of an NFL practice facility, they have like 20 locations. They have ads on the radio as an urgent care. Why will they not bill as an urgent care. My own insurance has said they'll pay if they change their billing but they will not. I've told them I wont' pay until they do and they said they'd put it to collections. Why would they refuse to bill for the service they provided and go through all this work?
In my state (MN) the attorney general's office will investigate claims on your behalf and I'm debating going down that route, but before I go through this step, can anyone explain to me why they can advertise as one thing but bill as another? Is there something obvious I'm missing?
Edit: To clear up a comment below, it was an Orthopedic urgent care, not a PT. The organization does both orthopedic urgent care and PT but who I saw was on the orthopedic side. I used the wrong term.
Also, as I read the bill closer, my insurance paid out $0, but the urgent care being in-network they did a $12 adjustment (instead of the 100% as it says on the back of my insurance card).