by Frankie Cook remembers last year’s car accident only with flash.
She was driving a friend home from high school on a winding road outside Rome, Georgia. He saw standing water from a recent rain. She tried to slow down but lost control of her car in a sharp turn. “The car flipped about three times,” Frankie said. “We spun and went off the side of that hill. My car was on its side and the back end was smashed into a tree.”
Frankie said the airbags deployed and both passengers were wearing seat belts, so she was left with a headache when her father, Russell Cook, came to pick her up from the crash site.
Frankie, then a high school student, was concerned that she might have a concussion that could affect her performance on an upcoming Advanced Placement exam, so her father and she decided to go to an urgent care center near their home to have her treated. check. They didn’t make it past the front desk.
Russell Cook
“We don’t take third-party insurance,” Russell said the receptionist at Atrium Health Floyd Urgent Care Rome told him, though he wasn’t sure what she meant. “He told me three times.”
Urgent Care Clinics vs. ERs
The problem didn’t seem to be that the clinic didn’t have the medical expertise to evaluate Frankie. Instead, the Cooks appeared to be dealing with a reimbursement policy often used by urgent care centers to avoid waiting for payments from auto insurance settlements.
Russell said to take Frankie to an emergency room, which by law must see all patients regardless of such matters. The closest, Atrium Health Floyd Medical Center, was about a mile down the road and belonged to the same hospital system as the urgent care center.
There, Russell said, a doctor looked at Frankie “for just a few minutes,” ran precautionary CT scans of her head and body and sent her home with the advice to “take some Tylenol” and rest. He did not have a concussion or serious head injury and was able to take the AP exam on time.
Then came the bill.
The patient: Frankie Cook, 18, now a freshman from Rome, Georgia;
Medical services: A medical evaluation and two CT scans.
Service provider: Atrium Health Floyd, a hospital system with urgent care centers in northwest Georgia and northeast Alabama;
Total bill: $17,005 for an emergency room visit. It was later adjusted to $11,805 after a duplicate charge was deducted.
What it gives: The Cooks hit a hazard in the health care system after Frankie’s car hit that tree: More and more hospital systems have urgent care centers, which have limits on who they treat — both for financial and medical reasons.
Audra Melton for KHN
Russell was quite upset after receiving such a large bill, especially when he had tried to make a quick, cheap trip to the clinic. He said Frankie’s grandmother was seen at an urgent care center after a car wreck and left with a bill for just a few hundred dollars.
“I kind of expected that,” he said. “They really should have looked at her.”
So why was Frankie removed from an urgent care center?
Lou Ellen Horwitz, CEO of the Urgent Care Association, said it’s a fairly standard policy for urgent care centers not to treat injuries resulting from traffic accidents, even minor ones. “Generally, as a rule, they don’t take care of car accident victims regardless of the extent of their injuries because they’re going to go through that auto insurance claims process before the provider gets paid,” he said.
Thin margins
Horwitz said urgent care centers — even those owned by large health systems — often operate on thin margins and can’t wait months and months for an auto insurance company to pay a claim. He said that “unfortunately” people tend to learn about such policies when they show up expecting care.
Throw in the complex relationship between health and auto insurance companies, and you have what Barak Richman, a professor of health care policy at Duke University Law School, called “the complex world we live in.”
“Each product has its own specifications about where it goes and what it covers. Each one is incredibly difficult and complex to manage,” he said. “And everyone imposes errors on the system.”
Atrium Health did not respond to repeated requests for comment on Frankie’s case.
Profit strategy?
Horwitz rejected the idea that a health system could push people in car wrecks from urgent care centers to emergency rooms to make more money off of them. However, auto insurance generally pays more than health insurance for the same services.
Richman remained skeptical.
“At the risk of sounding a little too cynical, there are always dollar signs when a healthcare provider sees a patient walk through the door,” Richman said.
Dr. Ateev Mehrotra, professor of health care policy at Harvard Medical School, said it’s likely to be strategic for the urgent care center to be located directly below the ER. Part of the strategy makes sense medically, he said, “because if something bad happens, you want to get them somewhere with more capacity very quickly.”
But he also said that urgent care centers are “one of the most effective ways” for a health system to generate new revenue by creating a pipeline of new patients who will visit its hospitals and later see doctors for tests and follow-up.
Mehrotra also said urgent care centers are not bound by the Emergency Medical Care and Labor Act, a federal law known as EMTALA that requires hospitals to stabilize patients regardless of their ability to pay.
At the time of Frankie’s visit, both the urgent care center and the emergency room were owned by the Floyd Health System, which operated a handful of hospitals and clinics in northwest Georgia and northeast Alabama. Floyd has since merged with Atrium Health — a larger North Carolina-based company that operates dozens of hospitals across the Southeast.
Frankie underwent a CT scan of her head and body in the emergency room, KHN’s tests confirmed that she could not go to the urgent care center, regardless of whether the test was medically necessary or just part of a protocol for people in wrecks of cars complaining of a headache.
Analysis
Sixteen months have passed since Frankie Cook’s hospital visit and Russell has delayed paying the bill after advice from a family friend who is a lawyer. After insurance covered its share, the Cooks’ share came to $1,042.
Achieving that number was a frustrating process, Russell said. He heard about the original $17,005 bill in a letter from a lawyer representing the hospital — another troubling wrinkle in Frankie’s care stemming from the car wreck. The Cooks then had to go through a lengthy appeals process to remove a $5,200 double charge from the bill.
Anthem Blue Cross Blue Shield, the Cooks’ insurance company, paid $4,006 for the claim. It said in a statement that it is “committed to providing access to high-quality medical care for our members. This matter was reviewed in accordance with our clinical guidelines and billed claims were processed accordingly.”
“It’s not going to put us on the road,” Russell said of the $1,042 balance, “but we have expenses like everybody else.”
He added, “I would have loved a $200 urgent care visit, but that ship has sailed.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth health journalism. Along with Policy Analysis and Polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides health information to the nation.
