Independent emergency facility vs. urgent care: Know the difference for insurance reasons - FOX 31 Denver

LAKEWOOD, Colo. (KDVR) — These days you have your choice between a standard urgent care facility or a free-standing emergency department. It’s important to know the difference because your insurance company does and will charge accordingly.

Cathy Crynes visited the Swedish Medical Center Belmar facility after injuring her wrist. She said after receiving treatment, she discovered a bill for more than $5,000.

“There should be at least some type of discussion about if you enter this building you enter your own risk and you need to be prepared what its bills might be,” she said.

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Crynes asked the FOX31 Problem Solvers to assist her in obtaining an itemized bill, which Swedish Medical Center promptly provided.

Crynes told FOX31 she then contacted her insurance company. Her bill and $500 deductible were reduced.

“I am overjoyed, I’m so thankful,” she said.

Swedish issued a statement to FOX31 explaining “our emergency departments and FSEDs are clearly marked as such and provide a different level of care than an urgent care facility.”

Swedish emphasizes that all pricing is competitive and adds “the amount patients actually pay for emergency department services has more to do with the type of insurance coverage they have than ‘prices’ or ‘charges’ of the hospital.” The full statement is included below.

Experts say it is important to understand the type of service and billing at your nearest urgent care before an emergency occurs. Copays and other charges may be based on the type of facility you visit.

Statement from Swedish Medical

“At Swedish Medical Center, our emergency departments and freestanding emergency departments (FSEDs) help us to meet the community’s need for emergency care close to home and all of our emergency rooms are staffed by board-certified emergency physicians. Our emergency departments and FSEDs are clearly marked as such and provide a different level of care than an urgent care facility. In addition, emergency departments and FSEDs do not turn anyone away based on ability to pay while some urgent care clinics may not accept Medicaid or those without financial resources. Swedish Medical Center aims to serve the community and provide the highest level of care when it is needed.

The amount patients actually pay for emergency department services has more to do with the type of insurance coverage they have than “prices” or “charges” of the hospital. Our pricing is competitive and varies based on a number of factors, including the health status of the patient, the expertise of physicians, and the technology and equipment used in providing care. We do not determine a person’s deductible or coinsurance; this is determined by their health insurance. The level of care designation is based on specific billing codes as well as guidance provided by the Centers for Medicaid and Medicare.

The move toward higher-deductible insurance plans has put a strain on many of our patients, but we understand their choice to pay a lower monthly premium, and we also understand their frustration with the larger out-of-pocket expenses they may experience as a result. Swedish Medical Center always works with patients on all billing inquiries and provides our patients with flexible options such as payment plans.

We also believe consumers should consider many factors when making healthcare decisions which is why we provide education on appropriate access points for care on our website. We have also proudly partnered with the Colorado Hospital Association on an important community education initiative to educate Coloradans about their healthcare options before they have an unexpected health need. You can find out more about this partnership at WhereForCare.org.”

Swedish Medical Center

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