Emergency Care is Unlike Other Forms of Healthcare

The media and insurance providers often draw comparisons between freestanding emergency centers and urgent care facilities, despite their drastically different levels of services. There are a number of aspects that differentiate emergency care from other forms of medical care. TAFEC is here to highlight what makes freestanding emergency room visits unique, and how billing practices of freestanding emergency centers might differ from primary care physicians or urgent care centers.

EMERGENCY CARE IS UNEXPECTED
Emergency care visits are unplanned. Patients don’t schedule ahead or shop out where they are going to receive emergency care beforehand like they do for primary care physicians and urgent care facilities. Patients visit freestanding emergency centers because a medical emergency has occurred. This is why freestanding emergency centers must be ready for any type of injury or illness presented at their facility. Read our Cost of Readiness blog.

PATIENT PROTECTIONS AND INSURANCE
Unlike primary care physicians and urgent care facilities, freestanding emergency centers aren’t able to discuss a patient’s insurance plan until a medical screening has been offered. It is the physician’s responsibility to ensure that the patient is stable before discussing costs of treatment or whether a specific insurance plan is in-network or out-of-network. In Texas, state law mirrors EMTALA regulations, which were enacted to protect patients and ensure patients receive the emergency care they require.

Additionally, it is impossible to predict costs of a patient’s visit before understanding the extent of the injury or illness through diagnostic testing. However, it is important to remember that insurance companies are expected to process the claim at the in-network rate under the prudent layperson standard.

MEDICAL SCREENING AND DIAGNOSTIC TESTING
Freestanding emergency centers, along with other emergency care facilities, can’t treat a patient without diagnosing what is wrong. As part of a medical screening offered to all FEC patients, emergency-trained, board certified physicians might perform a number of medical tests to identify the injury or illness before determining a treatment plan. A patient could be experiencing chest pain, causing the physician to perform an EKG to determine whether the patient is suffering from a heart attack or from something minor like indigestion. These medical tests are critical for protecting patients and saving lives, and they are typically the largest expense of a patient’s visit. Primary care physicians and urgent care facilities are not equipped to test for these types of medical emergencies.

EMERGENCY LEVEL RESPONSIVENESS SAVES TIME, SAVES LIVES
The costs of maintaining this type of state-of-the-art medical equipment, coupled with staffing FECs with quality physicians and nurses 24/7, is reflected in the technical component (facility fee) portion of a patient’s bill. Most patients appreciate the FEC’s attention to detail, speed of service, and convenient access to care. However, once patients receive their medical bill, they may not remember they received the same diagnostic testing and care that would have been administered in a traditional hospital – just without the wait.

In the media we see complaints to the effect of, “I was only at the FEC for 45 minutes and my bill was $900.” That speedy service is the very benefit that FECs uniquely offer patients. Sometimes patients question whether some of these lifesaving tests were necessary in the first place. The answer is always yes. It is the responsibility of the physicians and staff to serve and care for patients to the best of their ability, which is what all TAFEC members do on a daily basis.

PREPARE FOR YOUR NEXT EMERGENCY
Because the need for emergency care can happen at a moment’s notice, it is helpful to plan out where to go when an emergency occurs. Remember that emergency care is meant for medical emergencies and it comes with the cost of readiness. The more you know about freestanding emergency centers and how they different from other healthcare providers, the more prepared you’ll be in an emergency situation.

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