Got Sick Kids? Beware of the Zonk at the Freestanding ER

Like many Gen-Xers, I watched a lot of TV game shows when I was a little kid. With only four TV channels and cartoons restricted to Saturday mornings, game shows are what passed as educational programming back then (and possibly a babysitter).

One of my favorites was Let’s Make a Deal. The contestants were dressed in goofy costumes (Halloween costumes, to my four year old eye) in hopes of catching Monty Hall’s eye and a chance to trade prizes for better ones. Do you want Door No. 1, No. 2, or No. 3?

I loved it when contestants got “zonked,” a junk booby prize like a goat instead of the car the contestant was hoping for. Though, to a four year old, a goat seemed like a pretty good prize. And true fact, contestants did legally win the zonks. To read more about how that worked, click here.

There is one place in real life where you can “zonked” if you don’t choose carefully, urgent care clinics vs. freestanding ERs.

There’s a difference? You bet your wallet there’s a difference.

Texas, like many other states, permits freestanding emergency centers, facilities that are independent of hospitals and capable of providing acute care around the clock. According to the Texas Association of Freestanding Emergency Centers, there are at least 40 freestanding ERs in the Dallas-Fort Worth metroplex, mainly in middle-to-high income areas.

An ER right in your neighborhood? Sounds convenient, right? So, what’s the catch? Unlike urgent care clinics, freestanding ERs can charge hospital emergency room charges and they frequently aren’t in insurance networks.

While freestanding ERs resemble urgent care clinics, at least in Texas, they are required to have the word “emergency room” or “ER” in their title and to post notice of what, if any, insurance networks they’re in.

I inadvertently got “zonked” taking one of of my kids to a freestanding ER and I am betting other parents have had similar experiences.

It’s 8:30 p.m. and my three year old steps on a nail, getting a bad cut on her heel. Thinking the cut is beyond the healing power of a Paw Patrol band-aid, I quickly research my options. Our go-to pediatric urgent care clinic closes at 8:00 p.m. I know from past experience that the nearest hospital ER won’t admit pediatric patients and instead sends parents to one of the three local children’s hospitals, the nearest of which is a 30 minute drive.

So I decide to take her to a new place in our neighborhood that advertises itself as an “ER and Urgent Care Clinic.” We walk in at 8:50 p.m. and after a 10 minute wait behind a man who may have coughed up a lung, we get to the front desk. “It’s 9:00 p.m.,” the receptionist tells me. I glance down at my watch and nod. “It’s 9:00 p.m.,” she says more urgently as she hands me an iPad to begin the check-in process.

I was a little too preoccupied with the bleeding toddler, but apparently what this lady was trying to remind me is that at 9:00 p.m., the clinic magically transformed from an urgent care clinic to a freestanding ER. That’s right, the billing completely changes overnight (and no, there is no change in the quality of care).

To be fair to the clinic, there was plenty of notice of the change in charges, which I didn’t take the time to read because I was trying to entertain the bleeding toddler.

The doctor took a look at the cut. He wasn’t “100% sure” it needed to be stitched, which he couldn’t do anyway since the clinic did not have the right size needles for such a small foot. He asked the nurse to put a big non-cartoon band-aid on the cut and told me to follow up with my pediatrician in the morning. Probably two minutes of the doctor’s time, and three minutes of the nurse’s time.

You know where I am going with this. Four weeks later, I get a bill in the mail for $461, the difference between what the clinic charged and what my insurance was willing to pay.

So what should you do if you find yourself in a similar situation?

First, pay better attention than I did so you know what you are getting yourself into. These places are required to give adequate notice (signs, on the website, on the admission forms), and they do. When you don’t have an emergency on your hands, check with your insurance provider to see which clinics are in network and what your ER visit coverage is.

Second, if you find yourself in a freestanding ER, don’t be afraid to ask the doctor before you are admitted if this is a true emergency or if an urgent care clinic would also be appropriate.

Finally, if you are like me and don’t think about the consequences of the visit until after you get the bill, you can challenge the bill. Ask for itemized invoice and check for errors (for example, medicines not received or procedures not performed).

In my situation, I called the billing department at the clinic. I pointed out that they were essentially charging me $461 for a band-aid and that the clinic did not have the proper materials (pediatric size suture needles) on hand to deal with a common child injury. The billing department was understanding and dropped the charge.

What have your experiences been with urgent care clinics vs. freestanding ERs? Leave a comment or send me an e-mail.

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