Prices at minor emergency clinics

I've had two minor emergency visits in the last few months, at different facilities. (Not in NJ.)

The first one was for an ear infection. Five minutes with a physician's assistant, no labs, and a prescription. Not covered by insurance, so I paid cash, which came to $167.

The second visit was for traveller's diarrhea after a trip. Five minutes with a physician's assistant, no labs, and a prescription. This one was covered by insurance, so I paid the Urgent Care Professional Copay ($75). I just received the statement, and my insurance company paid $1,275 for this visit (in addition to my copay).

WTF? Is this the normal difference between cash and insurance? Or was the second place a more advanced facility with a higher level of service and higher prices? (Looked the same to me, but that rate seems like what you'd get from a regular hospital emergency room.)

I want to be a responsible, cost-effective consumer of medical services, but how do I do that? I asked the second place about their rates, but all they would tell me is that I would only be responsible for the copay. Should I care, as long as I don't have to pay out of pocket? I guess if my insurance is willing to pay, it's not my problem.

Are you sure that that's how much your insurance company paid, and not just what they were billed? I often see huge differences between what's billed and what the insurance company adjusts it down to.

Some of the "urgent care" places are rebranding? reorganizing? themselves as hospital outpatient, or some kind of satellite ER. The one we have used for years for urgent care (since it's impossible to get a prompt appointment with our regular physician) has changed, according to the local paper, so that its charges are massively higher than before. Apparently, a smallish, not very explicit sign was posted. Just the latest medical rip-off, jmho.

(not in NJ)

eta, and yes, I think we should care, since ultimately we're all paying for it one way or another, in insurance premiums, govt outlays, forgone wages; but I have no clue what to do about it.

mjc said:
it's impossible to get a prompt appointment with our regular physician

This was a major issue with my previous doctor, sick visits were scheduled a week or more out so I would end up at walk in places. Last year I switched to a new doctor. Sick visits are now scheduled same day or one day out. I only wish I had switched practices sooner.

Any medical practice that can't accommodate a sick visit within a day (or maybe two at most) has a problem. I would definitely be switching away from that situation.

ParticleMan said:
Are you sure that that's how much your insurance company paid, and not just what they were billed? I often see huge differences between what's billed and what the insurance company adjusts it down to.

The amount billed was $2,125. The amount paid (insurance + deductible) was $1,350. This is nuts.

Crazy. But mjc is right. There are facilities that look like urgent care, but are actually stand alone ERs.

kthnry said:

Treatment of turista at minor emergency center: billed $2,125; paid $1,350.

Annual mammogram: billed $1,037; paid $204.30 (including my deductible). That's for sophisticated radiology equipment plus review by an actual physician. How does this make any sense? (Sorry, I'm obsessing now.)

spontaneous said:

mjc said:
it's impossible to get a prompt appointment with our regular physician

This was a major issue with my previous doctor, sick visits were scheduled a week or more out so I would end up at walk in places. Last year I switched to a new doctor. Sick visits are now scheduled same day or one day out. I only wish I had switched practices sooner.

How's that ACA going for ya??

Why are you opting for emergency care? Are you no near your primary care physician?

mammabear said:

spontaneous said:

mjc said:
it's impossible to get a prompt appointment with our regular physician

This was a major issue with my previous doctor, sick visits were scheduled a week or more out so I would end up at walk in places. Last year I switched to a new doctor. Sick visits are now scheduled same day or one day out. I only wish I had switched practices sooner.

How's that ACA going for ya??


Why are you opting for emergency care? Are you no near your primary care physician?

That isn't what I read in that post. Sounds like she is now getting sick care on a timely basis from her primary care doc. Which is as it should be.

What did I miss?

mammabear said:

How's that ACA going for ya??

Why are you opting for emergency care? Are you no near your primary care physician?

No, I'm in a different state from my PCP.

My ACA plan is great. Thanks for asking. Since I travel a lot and spend part of the year in Texas, I got a Texas BC/BS plan that covers me anywhere in the US for the same price as my previous NJ plan, which didn't cover me outside NJ. All I pay is the copay, so it doesn't matter to me how much a provider charges. I'm just trying to determine the most cost-effective way to get treatment because it seems like the right thing to do. The Republicans would like for us to be responsible healthcare consumers, but I don't see how that is possible given the byzantine structure of healthcare costs.

sac said:

mammabear said:

spontaneous said:

mjc said:
it's impossible to get a prompt appointment with our regular physician

This was a major issue with my previous doctor, sick visits were scheduled a week or more out so I would end up at walk in places. Last year I switched to a new doctor. Sick visits are now scheduled same day or one day out. I only wish I had switched practices sooner.

How's that ACA going for ya??


Why are you opting for emergency care? Are you no near your primary care physician?

That isn't what I read in that post. Sounds like she is now getting sick care on a timely basis from her primary care doc. Which is as it should be.
What did I miss?

My plan hasn't changed with ACA. We have the same exact plan now that we had in 2009. My previous doc who scheduled sick visits a week+ away and with hour long waits in for any visit, sick or routine (including 9am appointments before the day gets behind schedule) was well before ACA. My new doc is prompt and sick visits are same or next day.

I don't understand what ACA has to do with my old doc being bad at managing time/appointments. Oh, and I received a bill 20+ months after a visit from his office and their only reply was that it was legal since they billed me within 24 months, again this was before ACA. The whole office was just a mess.

With my new doc I've opted for urgent (not emergency) care twice in the past year, once on a week night after normal office hours when my eye became swollen and oozy and hot pink and very painful. In hindsight after recently reading about the woman who lost her sight by waiting 12 hours to have a bad eye infection treated I'm glad I didn't wait and BCBS obviously agreed since they paid the bill with no hassle. The second time I went was when my chest became tight and I was having difficulty breathing on a Sunday. I'm sure any reasonable person would agree that not waiting until the office was open Monday morning was the right thing to do.

Since I was able to keep my old plan and since I am now getting excellent medical care I guess the answer to your question is that ACA is going just fine for me, thanks

sac said:

That isn't what I read in that post. Sounds like she is now getting sick care on a timely basis from her primary care doc. Which is as it should be.
What did I miss?

I get routine care from my PCP, but in the last year I've had a few minor incidents outlined above when I was out of state and couldn't wait until I got back to NJ. I'm just marveling at the huge discrepancies in charges for services.

From the subsequent 'chatter' I gather that mammabear quoted a different post than the one she was actually responding to (?)

No, mammabear sells insurance and the online marketplaces cut out the agents and she's clearly feeling threatened.

kthnry said:

sac said:

That isn't what I read in that post. Sounds like she is now getting sick care on a timely basis from her primary care doc. Which is as it should be.
What did I miss?

I get routine care from my PCP, but in the last year I've had a few minor incidents outlined above when I was out of state and couldn't wait until I got back to NJ. I'm just marveling at the huge discrepancies in charges for services.

That's what I asked the question. The answer is that you were out of state.

As far as ACA, the state plans differ. NJ does not allow for out of state coverages on individual plans. So you need a second plan? How is that good? And services are being billed with huge swings in fees. A mess

Honey, services have been billed with huge swings in fees for many years. There are about 10,000 articles documenting this. It's one of the huge problems with our system that predates the ACA.

Steve said:
No, mammabear sells insurance and the online marketplaces cut out the agents and she's clearly feeling threatened.

I am licensed to sell insurance, yes. The online marketplaces have not interfered with my business in the least. In fact, I think they help people who qualify for the credits. I help the others

I am all for insurance reform. We clearly need it. I do, however, have issues with the way ACA has impacted so many people in a negative way.

mjh said:
Honey, services have been billed with huge swings in fees for many years. There are about 10,000 articles documenting this. It's one of the huge problems with our system that predates the ACA.

My point exactly. So ACA was supposed to fix this, right? Yet it has not.

I thought the ACA was to help provide millions of people with health care.

dave said:
I thought the ACA was to help provide millions of people with health care.

This was the promise, and it's been delivered.

dave said:
I thought the ACA was to help provide millions of people with health care.

It was supposed to fix everything for everyone everywhere. Since it didn't, I'd like to register my opposition.

dave said:
I thought the ACA was to help provide millions of people with health care.

Actually it's "access to health care".

So, what do you suggest instead of ACA?

mammabear said:

mjh said:
Honey, services have been billed with huge swings in fees for many years. There are about 10,000 articles documenting this. It's one of the huge problems with our system that predates the ACA.

My point exactly. So ACA was supposed to fix this, right? Yet it has not.

mammabear asks: "How's that ACA going for ya?? Why are you opting for emergency care? Are you no near your primary care physician?"

Since I was also quoted in mb's post, I'll respond:

1. ACA: No apparent change in spouse's and my very good coverage. Able to obtain coverage for relative with pre-existing condition. Yay!! Vast, vast relief!!

2. I'm not opting for emergency care. I went to the urgent care place (before it became an "ER") when I was very uncomfortable but not in any medical danger, and my PCP's office suggested I'd be seen there sooner (same day) than at PCP's office. Also, I was sure I was just going to be referred to a specialist, so why take the PCP's time? On other occasions, our adult son who lives elsewhere has used the urgent care when he shows up at holidays with problems he hasn't addressed. I hope that doesn't come up again, because I'm not sure where he could go without his insurer being ripped off.