http://www.hospitalbillreview.com/blog.php?post=36
http://www.jsonline.com/watchdog/pi/110892474.html
ER billings from urgent care clinic draws complaints
Wheaton Franciscan practice peeves patrons
Karl Kaiser took his daughter, Teresa Kaiser, to the Wheaton Franciscan Healthcare urgent care facility in Wauwatosa to have her sore foot X-rayed.
He left with a $455 headache.
Teresa, a college student and marathon runner, had her hand X-rayed a year earlier at an urgent care clinic in Madison. That visit cost Kaiser $200.
Kaiser later learned that Wheaton Franciscan's clinic at 201 N. Mayfair Road, where he took his daughter in July, is unlike most urgent care clinics.
Kaiser said he was drawn in by the large, neon-red letters outside the building that read "urgent care."
He missed the 18-by-24 inch sign in the lobby. Under the heading "Thank you for choosing us for your health care," the sign says services may be billed as a hospital charge, and hospital emergency room co-payments, co-insurance and deductibles may apply.
The clinic also has brochures that explain the billing process - but patients get those only after they've been treated.
Kaiser says he should have been informed ahead of time.
"Urgent care in my mind meant something," said Kaiser, who has a high-deductible health plan. "I was expecting a couple hundred bucks."
Wheaton Franciscan officials said their urgent care center offers services beyond normal urgent care clinics, including around-the-clock availability.
"There's no general consistent definition of urgent care. Ours is more like an emergency department," said Coreen Dicus-Johnson, senior vice president of physician and revenue operations.
However, no ambulances take patients to the urgent care clinic, and no emergency surgery is performed on site.
In contrast, most urgent care clinics are seen as an extension of a doctor's office and bill at comparable rates.
That's the type of service most patients think of when they hear "urgent care," said Kevin Behl, who oversees Columbia St. Mary's Cathedral Square Urgent Care Center in downtown Milwaukee.
"It's supposed to be an alternative to an emergency room," Behl said.
Although Wheaton Franciscan's clinic is licensed for urgent care, the health care system contends it provides a much higher level of services, and that necessitates higher prices.
Aside from being available around the clock, the clinic offers full service imaging with on-site X-rays and MRIs.
Also, the clinic is staffed with emergency-care physicians and registered nurses qualified to handle patients whose hearts have stopped and are not breathing.
Wheaton Franciscan said that its clinic is an extension of Wheaton Franciscan Healthcare-St. Joseph, its hospital seven miles away, and subject to the same federal rules that apply to emergency departments. That prohibits hospitals from discussing rates and insurance before assessing a patient to determine if the person's condition is an emergency.
Bryan Schultz doesn't buy Wheaton's explanation, and he views its practice as deceptive.
His family used Wheaton Franciscan Healthcare for years - until he got the bills for two family visits.
He took his daughter to the facility after she had been wheezing for two straight days in March 2009, and a couple weeks later his wife visited with bronchial congestion.
He called ahead to verify that the clinic was for urgent care and not emergency care. So when the bills came to approximately $600 each, with physician fees labeled as "emergency," Schultz was livid.
"I have a problem when I call up and I ask 'Is this urgent care?' and I'm told on the phone it is, and then I'm getting ER billings," said Schultz, who never saw the explanatory sign in the lobby.
He emphasized that he had no qualms with the service or physicians.
Billing for services
Patients who receive treatment from the clinic are billed for two separate services. Wheaton Franciscan gets a facility fee, and the doctors get a physician fee.
The physician fee is based on the rates that emergency physicians charge, and the physicians are part of a practice that contracts with Wheaton. They bill health plans at emergency department rates.
"The Wheaton Franciscan Healthcare-Wauwatosa's Urgent Care Facility meets the definition of an Emergency Department for billing purposes," said Anne Ballentine, Wheaton vice president of communications. "Patients ?.?.?.?can expect the same level of quality as any emergency department."
Wheaton Franciscan does not recommend that patients in need of emergency care go to the clinic, however.
Most of the health plans that include the clinic in their networks pay facility fees that are 25% less on average than they would pay for similar services at a Wheaton Franciscan emergency department, Ballentine said.
Some plans - about 10% of those that contract with Wheaton - pay rates closer to those of an emergency department but still slightly less.
But the rates - even when 25% less than an emergency department - still are higher than the typical urgent care clinic.
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