A little over five years ago freestanding ERs started dotting the US landscape, with over 50% of these clinics located in Texas alone. While these facilities may look a lot like urgent cares on the outside, their services can cost over 10 times as much and a large percentage are not in-network for major insurance carriers. As a result, consumer advocacy and insurance groups have demanded increased legislation and oversight over these facilities to protect patients from surprise charges.
What are Freestanding ERs?
Freestanding ERs sell themselves on the idea that they can provide emergency services in a non-hospital setting. However, 75% of the diagnoses at these clinics are exactly the same as those at urgent cares. A recent study by researchers at Rice and other top Texas institutions found that many patients confuse free-standing ERs and urgent care centers and can be hit with sticker shock when they get a bill for several thousand dollars.
Why do they have such a negative reputation?
Consumer and advocacy groups, including the Texas Association of Health Plans, claim that freestanding ERs charge as much as hospital emergency rooms for their services but are ill-equipped to handle major emergencies threatening life or limb. They are responsible for around 70% of out-of-network emergency facility claims in Texas, which already leads the country in out of pocket spending on medical costs. By contrast, urgent cares average $168 for a typical visit.
What has been done to curtail them?
In 2014 Aetna won a multi-million dollar lawsuit against two Houston-based freestanding ERs for billing fraud conspiracy. Most recently, House Bill 3276, which has been passed along to Texas’ governor for final approval, aims at requiring freestanding ERs to be more transparent about their insurance network status, so patients can avoid deceitful billing practices and surprise costs.
How to spot a Freestanding ER
There are three main characteristics you can look for to avoid freestanding ERs:
- They look like an urgent care center and may be located near other retail, but include the word “Emergency” in their facility’s name.
- The clinic is situated on its own and does not appear to be connected to a hospital building.
- These centers are typically open 24 hours a day, 7 days a week, whereas urgent cares usually follow more regular business hours.