Surprise medical bills at urgent care

Earlier, critics of surprise medical billing (where patients can be billed for an out-of-network provider's services despite going to a facility that is considered in-network) celebrated a victory as Congress passed legislation that banned surprise medical billing leading to exorbitant patient bills. It turns out that the ban was for the practice at emergency rooms. Kaiser Health News reported on the practice being employed at urgent care centers, which are meant to be more responsive than most private practices, but less equipped than an emergency department. Perhaps legislation will be updated to include urgent care centers as well.

One of the problems is that it is difficult or time-consuming to tell whether a physician's services are covered by insurance. In the account reported by Kaiser Health News, the patient asked whether the physician's services would be covered by his insurance and received a reassuring but noncommittal response: "they should be covered." While bleeding and recovering from a bike crash, the patient would need to decide whether to stop the procedure to await confirmation or allow the procedure to continue and hope for the best. At a minimum, clinics should be able to tell patients quickly whether a provider accepts the patients' insurance plans. What would be nicer from a patient perspective would be for a facility that accepts certain plans to guarantee that all providers at that facility will accept those plans. Under current arrangements, providers seem to benefit from the ambiguity of whether they accept the patients' insurance.