#7: Ability to Pay

In our current highly charged atmosphere of disquiet over healthcare access and costs, it is natural to be concerned about the costs of urgent or emergency services and to wonder if a facility can turn you away if you don’t have insurance or can’t pay for services.

Urgent Care

In Colorado, urgent care clinics are not obligated to provide services to patients who are not able to pay. Because they are not licensed as facilities, they are not held to the same regulations as FSERs or hospital-based ERs; however, many urgent care clinics work with patients regardless of their insurance or payment status.

If an individual comes to an urgent care location with a true emergency, most centers will provide stabilizing services while waiting for Emergency Medical Services (EMS) to arrive, further assess the patient’s condition, and transport them to another level of care if necessary.

The urgent care clinic will usually bill insurance carriers with whom they already have contracts directly for their portion, then charge the patient for any deductible or co-pay that applies.

For uninsured, low-income, and high deductible patients, urgent care clinics may offer special payment plans, though they are not required to do so. For example, the Health Advantage Plan offered by NextCare Urgent Care in Colorado is a monthly membership designed for frequent users of urgent care. In 2016, the plan includes a one-time enrollment fee of $135 made payable at the first urgent care visit. Initial enrollment covers three months and is non-refundable but members may drop membership at any time. Under the Health Advantage Plan each in-house visit after enrollment is $35. The cost and/or availability of this plan will vary from clinic to clinic.[1]

Health Advantage Plans are also offered by private and public insurance groups and may look different than NextCare’s plan.

Some urgent care clinics may offer one-time use plans for uninsured or underinsured patients who use urgent care less frequently. For example, ValueCare (also through NextCare Urgent Care in Colorado) offers discounted services after a one-time annual fee of $50. Regular office visits under this plan are $80 and clinical office visits are $135. Payment is due at time of service.[2]

Free-Standing Emergency Rooms

In Colorado, FSERs are bound by EMTALA and therefore must treat, screen, and stabilize any person coming to the facility with an emergency before asking for their insurance status or ability to pay out-of-pocket. However, once stabilized a patient will be responsible for covering the cost of care received either with insurance or out-of-pocket.

The FSER will usually bill insurance carriers with whom they already have contracts directly for their portion, then charge the patient for any deductible or co-pay that applies.

Both FSER and UCC

If you have insurance, you may wonder if a facility is “in-network” or “out-of-network” and what the impact on cost and care would be.  

Hospitals, FSERs, and urgent care centers may contract with a single insurance company or multiple companies, though they are not required to do so.

If the patient has an insurance plan which does not have a contract with the FSER or center, they are considered “out-of-network” and the amount billed to the patient will be higher than if their plan had a contract.

Or, if the patient is unable or unwilling to pay at the time of service, the patient may be refused care if not a true emergency, or may be stabilized and transferred by an FSER because the insurance plan is not “in-network.”

Conclusion 

You have a right to be informed!  We hope this information will help you “know where to go” if the need arises and what to expect regarding ability to pay.

[1] NextCare Urgent Care. (n.d.). Medical Discount Programs. Retrieved from https://nextcare.force.com/OrderApi__campaign?id=a1Wj00000014IumEAE Accessed March 13, 2016.

[2] NextCare Urgent Care. (n.d.). Medical Discount Programs. Retrieved from https://nextcare.force.com/OrderApi__campaign?id=a1Wj00000014Ib6  Accessed March 13, 2016.