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Freestanding Emergency Rooms Can Be Confusing, Costly

Consumer complains free-standing ER’s look like urgent care clinics after getting an unexpectedly large bill

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    A consumer with a bad cold gets a bill for more than $1,000 after being treated at a freestanding ER. She says she thought she was being treated at an urgent care clinic. (Published Monday, April 27, 2015)

    Freestanding Emergency Centers look much like urgent care clinics, and so many consumers have confused the two, lawmakers are now considering legislation to require Freestanding Emergency Centers (FEC’s) have more signage to identify them as such.

    Frisco resident Pam Lee mistakenly visited an FEC during Thanksgiving weekend. She had a cough, sniffles, and chest congestion.

    "I think the kids just had the bad runny nose — and a couple of the other adults in the house did," said Lee.

    Lee wanted to get quick treatment for her symptoms so she could get back to enjoying her family over the holiday weekend. She thought she was going to an urgent care clinic which would likely have cost just her copay.

    "I just said, ‘I’m going to drive to a doc in the box,’" Lee told NBC 5.

    She said she went to Premier One Emergency Center in Frisco, only a few blocks from her home. But weeks later, a trip to the mailbox really made her really sick when she saw her bill.

    “I can’t believe they would charge that for a cold,” Lee complained.

    Her bill from the physician was just over $73. But the facility fee was $980. So the total cost for her cold was $1,053.11.

    "I just don't have a thousand dollars to spend on a cold," said Lee.

    When she called about the bill she was told she'd been to a free-standing emergency room — not an urgent care clinic.

    "I didn't know there was a difference,” Lee said. “I thought any little stand-alone clinic like that was a doctor's office," said Lee.

    But there's a big difference. While an urgent care clinic's billing is usually similar to that at your doctor's office, billing at a free-standing emergency room is like a trip to a hospital ER — complete with a facility fee.

    Since Texas passed a law setting licensing guidelines for these facilities, their numbers have exploded — from 25 centers in 2011 to 145 today.

    Dr. Mike Sarabia serves on the board of the Texas Association of Freestanding Emergency Rooms and said there are other big differences as well. At an FEC, patients are treated by an emergency room physician, not a nurse practitioner, which is often the case at urgent care clinics. And FEC’s have state of the art equipment and a lab to diagnose and treat emergency cases.

    "Overall patient satisfaction is tremendously high in the free-standing world. The largest system of emergency centers in Texas promotes that it's in the 99th percentile in patient satisfaction," said Sarabia.

    He said that's because at an FEC, patients will see doctor in minutes and each is open 24-hours a day. But free-standing emergency centers should be used for true emergencies, not a bad cold.

    “That is a fine line, and a difficult thing for some patients to comprehend,” said Sarabia.

    He said that’s why public education and transparency are key. State law requires FEC’s to have an ambulance entrance and use the word "emergency" in their signage.

    Premier One Emergency Center, the facility where Lee was treated, has both. It also is open 24-hours a day, as required by law. Urgent care centers are not open 24-hours.

    Lee said she had no idea free-standing emergency centers were true emergency rooms and would bill like any emergency room. After all, Baylor Hospital is also minutes from her home, and she would never have considered going there for treatment of her cold.

    Lee is not alone in her confusion. So many Texans have complained to state lawmakers after getting a big bill from an FEC, the legislature is considering a law mandating notices be posted in the lobby of free-standing emergency rooms. The bill is expected to reach the governor’s desk in May.

    Scott Pickett, CEO of Premier One Emergency Center said, "We believe in transparency and we believe in providing the right care at the right price."

    He said he’s making a number of changes like better signage and hiring a patient advocate manager. He said he’s waiving Lee’s bill because “it’s the right thing to do.”

    But he also points out that Lee signed a form acknowledging that his "emergency facility" would bill her insurance provider "under her emergency department benefits."

    It's a lesson lee said she won't soon forget.

    "You can't take it for granted anymore that you whip out your card; they take your copay, and you're done," said Lee.

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