A recent article in the New York Times, written by a doctor, revealed that different urgent care facilities sometimes charge wildly different prices, based on their status. The doctor’s daughter needed an x-ray, and the urgent care billed them for hospital-based x-rays. The doctor, who works in a hospital, was expecting a bill of around $200, but instead she received a bill for $1,168.
[Here is a link to the article. It is a “gifted” article so there should be no paywall.]
The doctor discovered that some urgent care facilities are hospital-affiliated, and are deemed to be “hospital outpatient departments,” or HOPDs. The article states, “there is no federal protection for patients who are unknowingly treated in higher-priced hospital affiliates that look like normal doctors’ offices or urgent care clinics.” In other words, nobody at the urgent care is required to tell you that they may charge you far more than the non-hospital-affiliated urgent care facility down the street.
A study by the National Institute for Health Care Reform (NIHCR) found that “Average hospital outpatient department prices for common imaging, colonoscopy and laboratory services can be double the price or more for identical services provided in a physician’s office or other community-based setting.” The study found that prices vary across and within local markets.
Hospitals, and the American Hospital Association, have attempted to justify these costs by claiming that HOPDs treat patients who are sicker. But often, regardless of the patient's health situation, the procedure is identical. A broken ankle x-ray is the same no matter who gets it or where it is performed. In addition, when someone needs urgent care, one clinic looks the same as the next. Charging a different price appears to have far more to do with a profit motive than the health status of the patient.
In recent years, hospitals have been acquiring physicans’ practices. In the case of urgent care clinics, this allows them to change the designation of what was formerly a community-based facility into an HOPD. Insurers often cover the same amount for a procedure regardless of where it is performed. The result is that a large bill for the amount over the covered cost often ends up falling on the patient who unwittingly used an HOPD. If the bills from your local urgent care provider have skyrocketed recently, you may be a victim of this status change.
Even more surprising to me, is that the NIHCR study about higher costs in HOPDs was published in 2014. I had never heard of this secret dichotomy before I read the NYT article. I called the walk-in clinic associated with the medical practice I usually use, and was told that yes, they are an HOPD. That would probably explain the egregious $300+ cost of a recent 10-minute visit to examine a large rash that surrounded a bug bite I received (Lyme test, extra cost, negative).
I checked several of the urgent care facilities in my area and their websites said nothing about their HOPD status. If you are using an urgent care facility, or might need to, it would make sense to call several, and if you can get through to a human being (not often an easy task), ask them. Finding an urgent care that is NOT billing as a Hospital Outpatient Department could save you thousands of dollars over time, or even in one visit.
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