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When it comes to billing, an urgent care center is different from an emergency center

A MARTÍNEZ, BYLINE: It's time for our June Bill of the Month. Dr. Elisabeth Rosenthal is senior contributing editor with our partner KFF Health News. Doctor, welcome back to the show.

ELISABETH ROSENTHAL, BYLINE: Happy to be here again.

MARTÍNEZ: All right. So what bill are we looking at this month?

ROSENTHAL: This comes from a Dallas man named Tieqiao Zhang, who goes by Tim. Last year, when he was dealing with severe stomach pain, Tim thought he was walking into an urgent care clinic for help, but was charged emergency room prices. Now he's having to pay 10 times what he expected.

MARTÍNEZ: Wow, 10 times. All right, so to hear how this happened, let's bring in reporter Emily Siner.

EMILY SINER, BYLINE: At the core of the confusion is the facility's name.

TIM ZHANG: Parkland Urgent Care Emergency Center - something like that.

SINER: In December, Tim Zhang went to the Urgent Care Emergency Center at Parkland Health, a major Dallas hospital. They told him he had a kidney stone that would pass on its own. Several days later and still in pain, he went back. They told him the same thing. And, sure enough, the situation finally resolved itself. But when the bills arrived, he felt another kind of pain. He expected to pay $50 for each visit. That's his copay for urgent care. Instead, the bill said that his share was $500, 1,000 bucks in total. Tim's first thought was...

ZHANG: There must have been some mistake.

SINER: It was not a mistake because the facility called Urgent Care Emergency Center doesn't consider itself urgent care. It's an emergency room, which is way more expensive. The difference between an urgent care clinic and a free-standing emergency room can be tough to discern. Emergency rooms generally have requirements like not refusing patients and being open 24/7. But this one is closed nights and Sundays. A Parkland Health spokesman told Bill of the Month that the center is considered a free-standing emergency medical care facility, in line with Texas law. He says it operates as an extension of the main emergency room on the same hospital campus. But Tim says, to him, it seems like most people working there don't understand that, based on his experience at the hospital in previous years.

ZHANG: If you go to the hospital, you ask them where is the urgent care? The staff will point you to that building.

SINER: The Parkland Health spokesman says the center's name is intended to help direct first responders to the main emergency room. But Tim says it feels misleading.

ZHANG: Just call it emergency room. I mean, if you have two, then just call it emergency room one, emergency room two. Avoiding confusion is definitely a part of the service.

SINER: But for Tim's confusion, he's still on the hook for the full $1,000. For NPR News, I'm Emily Siner.

MARTÍNEZ: We're back with Dr. Elisabeth Rosenthal with KFF Health News. And a note, the CEO of the Parkland Health System, Frederick Cerise, is a member of the KFF board of trustees. The KFF newsroom is an editorially independent program.

Now, Doctor, back to this case. Wow, the difference between emergency room and urgent care - what a difference some words make. Are there any regulations about what health facilities can actually call themselves?

ROSENTHAL: Yeah, what's a patient to do, right? Most regulations are about other kinds of transparency, not the name on the sign out front. Texas and some other states require emergency rooms to post printed disclosures about their billing practices. Parkland Health shared photos of notices posted in the Urgent Care Emergency Center that warn patients about emergency room fees. But, you know, there are often lots of signs, and when you're feeling bad, you don't read them when you enter a medical building. Tim Zhang says he doesn't recall seeing those signs about ER fees, and he says the reception staff didn't mention a $500 copay.

MARTÍNEZ: Yeah, it sounds like in some places, at least, I mean, patients are left on their own to figure out the best place to get care.

ROSENTHAL: You know, it's normal for patients to have to do a bit of self-triage. Like, does my health issue need an emergency room, or will an urgent care center suffice? If patients have to figure out if they're walking into an urgent care center or an emergency room, well, that's another level of work. Most people naturally think of an ER as in a hospital. But the number of free-standing ERs has grown rapidly in recent years, so more people are likely having the same experience as Tim. States could do more to untangle the confusion people face. Regulators could prohibit the use of the term urgent care to describe facilities that bill like an emergency room. Until that happens, the best thing to do is have your antenna up and ask a triage.

MARTÍNEZ: So beyond the name, Doctor, I mean, how does someone figure out what health services an urgent care can give versus an emergency room? I mean, it sounds like it's part of the confusion.

ROSENTHAL: Yeah, another level of confusion for patients. Today, the suite of services available can vary a lot from one urgent care center to the next. Some offer IV hydration, for instance. Others don't. At the Parkland free-standing urgent care ER, the list of services offered resemble the care you can get at an urgent care center. And I agree totally with Tim. If it bills like an emergency room, it would help patients not to use the term urgent care.

MARTÍNEZ: That is Dr. Elisabeth Rosenthal. Thank you very much, Doctor.

ROSENTHAL: Thank you for having me.

MARTÍNEZ: Now, if you have a confusing or outrageous medical bill that you want us to review, please go to NPR's Shots blog and tell us all about it. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

A Martínez is one of the hosts of Morning Edition and Up First. He came to NPR in 2021 and is based out of NPR West.
Emily Siner is an enterprise reporter at WPLN. She has worked at the Los Angeles Times and NPR headquarters in Washington, D.C., and her written work was recently published in Slices Of Life, an anthology of literary feature writing. Born and raised in the Chicago area, she is a graduate from the University of Illinois at Urbana-Champaign.