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Because healthcare and health insurance can be difficult to navigate, we often don’t understand how costly something can be until it’s too late. When CGHC asked me to tell my story about two urgent care visits I made, I was happy to do so in the hope that it would help others avoid, or at least be aware of, some billing practices that can potentially result in unexpectedly costly medical bills.

Last year, while I was spending a few days in the Fox Valley, I became ill. Hoping it wasn’t something serious, I went to an in-network urgent care clinic. I was seen by a nurse practitioner who was overseen by a physician, who ordered some lab tests and gave me a prescription. I later followed up with my own physician.

Because I have a deductible/coinsurance plan, I was responsible for paying nearly the entire cost associated with this urgent care visit. And although the cost was relatively high, it wasn’t surprising given my circumstance, and I knew a visit to the emergency room would have been considerably more expensive.

Fast forward a few months later when I had similar symptoms. Once again, I went to an in-network urgent care clinic for treatment, but this time I was back home in the Milwaukee area. I had the same type of exam, this time by a physician, who ran the same labs and gave me a similar prescription.

Imagine my surprise when I received my bill for the second urgent care visit. It was considerably higher than the previous one, even though the circumstances were identical – and it was the same health system.

What I learned is that the health system does not charge the same way for all urgent care visits; the physician has discretion to determine the level of care that was given, which affects the cost of the care. My first visit was billed as a “Level 2” visit. But my second visit was billed as “Level 4,” which led to considerably higher charges. Because I have a high deductible plan, I was responsible for most of the cost.

Here are some suggestions on how you can use information from my experience and from other billing practices to be better prepared about costs when you require medical care:

  • When selecting a plan, make sure you understand the differences among deductibles, copays and coinsurance.
  • Call the urgent care center before your visit and ask if there is a “facility fee” charged. Some urgent care centers are hospital-based, and the hospital charges an extra amount for the use of the facility, which adds to your bill.
  • Ask the physician or other medical professional who is providing your treatment about how your visit will be billed. If you can’t get the information, you can request the phone number for the provider’s billing department.
  • Check your bills carefully when you receive them. If something doesn’t look right, contact the healthcare provider and ask them to explain it. If something still doesn’t seem right, contact CGHC for help.

Member to Member is a feature in our blog and newsletter where real members talk about lessons learned while navigating the healthcare system. If you have a story you’d like to share with other CGHC members, please reach out to us at: MemberStories@cgcares.org

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