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At urgent care, he got 5 stitches and a big surprise: A plastic surgeon's bill for $1,040


Under a law Congress passed last year, many surprise medical bills will be banned starting in January. Patients with private insurance will be protected against unexpected charges for emergency out-of-network care, for treatment by out-of-network providers at in-network facilities and for transportation in air ambulances. But there is a gray area: visits to urgent care clinics, which have proliferated in recent years as patients seek speed and convenience over waiting hours at emergency rooms or weeks to get regular doctor's appointments. There are about 10,500 urgent care centers in the U.S., according to the Urgent Care Association, which lobbies on their behalf.



Bryan Keller: Surprise Billing for an Urgent Care Visit



Eight months after a bike accident resulted in five stitches and a plastic surgeon's bill at an urgent care clinic, Bryan Keller still has a visible scar.José A. Alvarado Jr. / for Kaiser Health News



Urgent care clinics weren't explicitly addressed in the No Surprises Act. Keller's experience underscores patients' predicament — insurers often try to steer patients to urgent care and away from costly emergency rooms, but they could still get hit with large bills. The Biden administration has expressed an interest in prohibiting surprise bills in clinics, which may treat serious conditions but not life-threatening injuries and illnesses.



Several federal agencies this month issued interim regulations that largely wouldn't protect patients from surprise urgent care bills. Regulation varies significantly across states. Before the surprise billing rules are finalized, the Department of Health and Human Services and three other agencies have asked, for instance, about the frequency of such bills at urgent care facilities and how health insurers contract with the clinics.



Experts say that if it's left untouched before the new law takes effect, the regulatory gap could leave patients at risk.



"There's a real interesting question about whether it should apply to the extent that people perceive these as places to go for an emergency," said Jack Hoadley, a research professor emeritus at Georgetown University's McCourt School of Public Policy.



CityMD, which was founded by doctors in 2010 and merged with the large medical practice Summit Medical Group in 2019, operates a massive chain of urgent care clinics in New York and New Jersey. The combined enterprise created Summit Health, which is backed by private equity investments from Warburg Pincus — which acquired CityMD in 2017 — and Consonance Capital Partners.

https://www.nbcnews.com/health/health-care/urgent-care-he-got-5-stitches-big-surprise-plastic-surgeon-n1275328



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