Frankie Cook has only fleeting memories of the vehicle accident from a year ago.
On a curvy road outside of Rome, Georgia, she was transporting a high school classmate home. She observed standing water after recent rainfall. On a sharp curve, she attempted to slow down but lost control of her vehicle. Frankie stated that the vehicle had around three rollovers. “We did a U-turn and went over the edge of this hill. My vehicle was on its side, and its rear end was lodged in a tree.”
Frankie reported that the air bags deployed and both passengers were wearing seat belts, leaving her with only a headache when her father, Russell Cook, arrived to pick her up from the crash scene.
Frankie, then a junior in high school, was concerned that a concussion could influence her performance on an impending Advanced Placement exam, so she and her father decided to visit a nearby urgent care center to have her examined. They were stopped at the main desk.
Frankie Cook was transporting a buddy home from high school when her vehicle veered off a winding country road near Rome, Georgia, overturned multiple times, and struck a tree. Frankie’s injuries were not severe, but her family encountered a new obstacle after an urgent care clinic refused to treat her for insurance concerns. Russell Cook
“We do not accept third-party coverage,” Russell stated that the receptionist at Atrium Health Floyd Urgent Care in Rome told him something, but he was uncertain of what she meant. She told me around three times.
Urgent care clinics versus ERs
It did not appear that the clinic had the necessary medical knowledge to evaluate Frankie. Rather, it appeared that the Cooks were dealing with a reimbursement technique that is frequently utilized by urgent care centers to avoid waiting for money from auto insurance settlements.
Russell was instructed to bring Frankie to an emergency room, which is required by law to treat all patients regardless of their condition. The closest one, located around one mile away at Atrium Health Floyd Medical Clinic, was owned by the same hospital system as the urgent care center.
Russell stated that there, a physician examined Frankie for “only a few minutes” before ordering precautionary CT scans of her head and torso and sent her home with instructions to “take some Tylenol” and relax. She was able to take her AP exam on schedule due to the absence of a concussion or major head damage.
Then, the bill arrived.
The patient is Frankie Cook, an 18-year-old college freshman from Rome, Georgia.
A medical evaluation and two CT scans are provided as part of the medical services provided.
Atrium Health Floyd, a hospital system comprising urgent care sites in northwestern Georgia and northeastern Alabama, is the service provider.
Total Charge: $17,005 for a visit to the emergency room; later reduced to $11,805 after a duplicate charge was deleted.
After Frankie’s car collided with that tree, the Cooks encountered a risk in the health care system. For both financial and medical reasons, an increasing number of hospital systems own urgent care centers, which handle fewer patients.
After Frankie Cook’s vehicle accident on a wet road outside of Rome, Georgia, her father, Russell (shown above), received a letter from a lawyer stating that they owed $17,000 for Frankie’s emergency care visit to determine if she had a concussion. Audra Melton for KHN
Russell was rather disappointed after receiving such a high charge, especially because he had attempted to visit the clinic quickly and inexpensively. He stated that Frankie’s grandmother was seen at an urgent care center following a car accident and left with a few hundred dollar notes.
“That’s roughly what I anticipated,” he remarked. Simply, she required a thorough examination.
So why was Frankie denied entry to an urgent care facility?
Lou Ellen Horwitz, chief executive officer of the Urgent Care Association, stated that it is routine practice for urgent care clinics not to treat even minor vehicle accident-related injuries. “As a general rule, they do not treat auto accident victims, regardless of the severity of their injuries, because the auto insurance claims process must be completed before the provider is reimbursed,” she explained.
Narrow margins
Even urgent care centers managed by large health systems generally operate on narrow margins and cannot wait months and months for an auto insurance company to fulfill a claim, according to Horwitz. She stated that “sadly” people typically hear about such regulations when they present themselves for care.
Barak Richman, a professor of health care policy at the law school of Duke University, described the reality in which we live as “extraordinarily intricate.”
“Each product has its own specifications on where it can be utilized and what it protects. Each is extraordinarily difficult and complicated to administrate “he stated. And each introduces errors into the system.
On multiple occasions, Atrium Health declined to comment on Frankie’s situation.
Profit planning?
Horwitz refuted the notion that a health system would steer automobile accident victims from urgent care facilities to emergency rooms in order to generate more revenue. However, motor insurance typically pays more for the same services than health insurance.
Richman kept his skepticism.
Richman stated, “At the risk of sounding a bit too cynical, there are always monetary signs when a healthcare provider sees a patient walk through the door.”
According to Dr. Ateev Mehrotra, a professor of health care policy at Harvard Medical School, the proximity of the urgent care clinic to the emergency room was likely deliberate. Part of the strategy makes sense from a medical standpoint, he explained, “because if something bad happens, you want to transfer them to a facility with greater skill as soon as possible.”
However, he also stated that urgent care clinics are “one of the most effective methods” for a health system to generate new money, creating a pipeline of new patients to visit its hospitals and subsequently see doctors for testing and follow-up.
Mehrotra also stated that urgent care clinics are not obliged by the Emergency Medical Treatment and Labor Act (EMTALA), a federal legislation that mandates hospitals stabilize patients regardless of their capacity to pay.
At the time of Frankie’s visit, the urgent care center and emergency department were both controlled by Floyd health system, which ran a number of hospitals and clinics in northern Georgia and northeastern Alabama. Since then, Floyd has merged with Atrium Health, a larger firm based in North Carolina that oversees dozens of hospitals around the Southeast.
Frankie received a CT scan of her head and torso in the emergency room, tests that KHN confirmed she could not have received at the urgent care center, regardless of whether the test was medically necessary or simply part of a protocol for automobile accident victims who complain of a headache.
Resolution
Since Frankie Cook’s hospital visit sixteen months ago, Russell has postponed paying any of the bill on the advise of an attorney family friend. After insurance covered their amount, the Cooks’ share was $1,042
Russell stated that achieving this number was a difficult endeavor. In a letter from the hospital’s attorney, he learned of the original $17,005 charge; it was yet another frightening aspect of Frankie’s care following the car accident. The Cooks were then had to engage in a time-consuming appeal to have a $5,200 duplicate charge removed from their account.
The Cooks’ insurer, Anthem Blue Cross Blue Shield, paid $4,006 for the claim. In a statement, it said that it’s “dedicated to providing our members with access to high-quality medical care In compliance with our clinical procedures, this case was reviewed, and claims were processed properly.”
Russell stated of the $1,042 amount, “It won’t put us on the street, but we have expenses like everyone else.”
He continued, “A $200 urgent care visit would have been ideal, but that ship has gone.”
KHN (Kaiser Health News) is a national news organization that delivers in-depth health-related journalism. KHN, with Policy Analysis and Polling, is one of KFF’s three primary running programs (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on national health issues.