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Doctor's Office, Urgent Care or Emergency Department - Part II

Questions pertaining to my last blog prompted me to answer how a person without health insurance should go about obtaining acute health care.

This is a follow up from my most recent blog titled . Mr. England, a frequent contributor to Wentzville Patch, asked a number a questions that I felt required answers far more in-depth than could be answered in the reply section.

Mr. England asked, “What if you don't carry health insurance? Where do you go then?”

The health care term for someone without insurance is “self pay.” I will be using that term throughout this blog. We hear a lot about health care in the U.S. some good but mostly it's bad. For those of us with health insurance some of the “where to go” questions are answered for us by the insurance company. But what if you are a self pay? The answer to that question is...shop around. Ask friends where they go. Use the Internet for it's vast array of information. Make decisions on where you want to go for minor illness and injuries as well as major problems. This will help you make fast, informed decisions when the time comes and your too sick or injured to take the time to research.

Preventative medicine is always the best way to go. That means you should establish a relationship with a primary care physician or family practitioner. These doctors will get to know you on a personal level. As a self pay patient you have to do some detective work to find the most cost effective health care for your situation. I did some calling and found that a recent doctors office visit I had would have cost me $132 dollars if I did not have insurance. This was a basic visit, no labs or medications.

This led to me wondering how expensive the other health care options are. I called two local hospitals and asked what it would cost if I were a self pay and came into the emergency department. I was told that the facility fee was $600 plus the doctors fee of around $350, which would be sent to you separate from the hospital bill. I was told that there is no required amount that you have to put down at the time of service. They will ask for something, whatever you can afford. After treatment you will be billed for the services. The hospital has charity programs and payment plans to help with the cost of your treatment.

Urgent Care centers are all different, some are owned by hospital systems and thus charge similarly to their E.D. A call to a local hospital-owned urgent care revealed a request for $50 at the time of treatment and all other charges would be billed. The person who answered the phone did not know the exact amount but estimated around $400 for the facility fee.

Our Urgent Care is a privately owned chain of urgent cares. A self pay individual will be asked to make a down-payment of $105 for the visit. All other charges such as medication administration, x-rays and lab work will be billed at a later date.

So, to answer your question, Mr. England, if you have a slight cough or other minor illness a visit to your private physician may be best so he can follow your progress and adjust the treatment accordingly. But if you don't want to wait a week or so to get an appointment, an urgent care is your next best option. Save the emergency room visit for true life threatening emergencies like chest pain or difficulty breathing.

The next question you raised was, “Do you make an appointment with a physician for a yearly check up or wait until something is a problem to the extent that you need an emergency room for a remedy?”

Unfortunately, we see far too many people at the urgent care and in the emergency rooms who have put off treating an illness or injury because they did not have enough money to get it treated in the early stages. The best answer is to get treatment as soon as possible. Many people without insurance do not have a family doctor. The emergency room becomes their doctor of choice. The main reason for this is they will not be turned away. All treatment will be billed. Since most people do not shop for the most cost effective treatment plan, they end up in debt. This is unfortunate because credit ratings are destroyed over mounds of hospital bills. People cannot buy cars, rent an apartment or purchase a home because of an illness that went too long and was treated at an emergency department for well over $1,000.

For those self-pay people in their 20s and 30s a yearly check up can be put aside due to relatively good health. But as we age and hit our 40s and 50s, yearly exams become more important. Cancer screenings like mammograms and colonoscopys are put off by the uninsured due to cost. What they don't know is that there may be charity organizations that can offset some of the expense. I contacted the American Cancer Society and found out that Mercy and St. Mary's offer reduced cost mammograms for those in need. I mention this because with a little research one can find help. These services can save thousands of dollars and it's unknown how many lives it may save.

The final question from Mr. England is this: “The ER cannot turn you away because you don't have insurance...a physician's office can. What about urgent care? Can they turn you away if you don't have insurance?

You're correct, the E.R. cannot turn you away and neither can an urgent care owned by a hospital. The doctor's office can turn you away because this is his private business and the same goes for privately owned urgent care facilities. The reality, though, is if someone walks, crawls or is carried into Our Urgent Care with a true life threatening emergency, we will treat them and arrange for transport by ambulance to the closest Emergency Department for definitive care.

I hope this answers your questions. It is my desire, with this blog, to educate our community about health issues. This has sparked my interest into the availability of charities in the St. Louis/St. Charles area that can help those in need with hospital expenses and cancer screening. Maybe future blogs will deal with this subject.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

Jared England September 23, 2011 at 03:08 PM
Thanks for your research and work for the answers to my questions. As you probably know, some of my questions were rhetorical. But the answers were excellent, nonetheless. One thing you did not mention that I think is important to know for self pay patients; you can speak to the hospital about paying a reduced rate if you pay up front and with cash. For example, if you needed a mammogram and the cost is $250, you may be able to pay as low as half of that if you make arrangements beforehand. You will never know if you don't try!
Ray Antonacci September 28, 2011 at 06:41 PM
Jared, That's right you can negotiate with the hospital. Also, if you have a stack of hospital bills, don't ignore them hoping they will forget about them. Contact the billing department and negotiate a payment plan that you can afford. They are willing to work with you if you communicate your hardship to them. Also, I figured some of the questions you asked you already knew the answers but someone else may not. That is why I took the time to research my answers and write another blog.

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