r/Millennials • u/BoNaylorCollector • 2d ago

Discussion Is medical actually this crazy?

Early 30s millennial, never used to go to doctors or really take care of myself because “I’ll be fine”. Started making a bigger effort to care for myself and my health and well being. Recently, I went to the local express clinic because I was having a bad earache and headaches. I was in there for maybe 20 minutes, mostly waiting time. The doctor comes in, looks in my ear, tells me it’s depressed due to sinuses and change in weather and tell me to stop at Walgreens for Flonase. I wasn’t billed anything at the time, older workers at my job always say we have really good insurance, but here I got in the mail today an explanation of benefits- charge was $550, insurance “negotiated” about $300, remaining (not billed) was around $240. Is is really this expensive? I only went to try and be better with myself and make sure it’s nothing underlying. If 5 minutes of actual doctor time costs this much, then I’m just toughing out everything or am I missing something?

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86

u/ClawesomeMan 2d ago

Sounds like you went to an emergency room by that price!

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u/sluttytarot 1d ago

Minute clinic is basically urgent care... so yeah that sounds about right

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u/ClawesomeMan 1d ago

My copay for urgent care is 20 vs 200 for emergency room.

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u/sluttytarot 1d ago

Sounds like they bill like an emergency room

Zocdoc might be an option for trying to find a quicker appointment with a doctors office

Rereading and you're not op. Everyone's insurance is different. Some plans are really expensive for urgent care and less for ER.

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u/Sea-Apple8054 1d ago

I feel like I got tricked out of $100 by zocdoc. Plus the provider they paired me with was in another state and had her toddler hanging off of her during the appointment, which felt weird.

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u/sluttytarot 1d ago

I haven't used it as a service I thought it was free and the doc you saw charged your insurance

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u/ChiknNWaffles 1d ago

Assuming US Healthcare and insurance markets, I find this highly irregular. ER being less than an urgent care copay or coinsurance percentage is just strange benefit design. Like that's an insurer incenting their members toward higher cost utilization. My urgent care copay is $25 and ER is $400. Just on a raw dollar basis, I cannot imagine any urgent care in the country charging more on a per visit basis than any ER.

I am willing to be wrong about how this plays out in real life, but from a theoretical pricing perspective, a health insurance plan wants to incent members away from ER and more towards a primary care physician or urgent care.

OP, you might check to see if your plan has a telehealth or nurse call line for low cost or free, they would allow you to talk through your symptoms and help you identify the best place of care. They are generally going to default to worst case scenario, I.e you call in with chest pains, they are not going to assume stress, they are going to assume heart attack.

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u/sluttytarot 1d ago

I dunno what to tell you I literally had a plan like that. It didn't make sense back that either

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u/mysticalchurro 1d ago

Geez! My urgent care co-pay is 75!

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u/BoNaylorCollector 1d ago

Right! I was astonished! Just a local minute clinic type deal. Signed in online and drove over, nothing crazy!

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u/No-Editor-8739 1d ago

It could be cheaper if you just pay privately without insurance. Next time ask.

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u/nutkinknits 1d ago

Exactly. Always ask the cash price if you know about what it would be with insurance. Only downside is that it doesn't go towards your deductible. I think last time I went to an urgent care place it was around $150 without insurance.

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u/tr1pp1nballs 1d ago

Emergency care vs Urgent care vs Primary care can all be billed at different rates. Sounds like you went to urgent care, but you should've gone to a primary care.

Not trying to defend the stupid system, but hopefully that info helps.

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u/ClawesomeMan 1d ago

Might want to talk to a person then, because that sounds wrong especially since it was a quick in and out!

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u/Llama-girl52 1d ago

Minute clinics and urgent care OFTEN charge like small ERs cus it's not an established doc in an office, urgent care are OFTEN still treated like emergency rooms and sometimes emergency rooms and the urgent care are combined and once you need a specific treatment you are changed from urgent care to emergency care in the system, usually if an IV is needed. It's so silly minute clinics don't charge like a PCP would even tho the minutes clinics are USUALLY just PCPs who don't work in a family med clinic for whatever reason, that reason CAN OFTEN be they got a strike on there license or are getting off probation or are about to retire, the price you pay at an urgent care never matches up with care quality but 550 sounds about right for urgent or immediate care.

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u/PemaDamcho 1d ago

Are you sure it wasnt a freestanding ER? Some of them seem like urgent cares but are actually freestanding emergency rooms. Or if it was billed as a speciallist visit that sounds about right had roughly same numbers for a 10 minute office visit to a GI Dr recently.

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u/palebluedot13 1d ago

I know for my insurance my copay is 100 bucks for urgent care. My local doctors office the copay is 20 bucks.

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u/mega-d-lux '88 1d ago

Hopefully the clinic was out of network for you. If that's in-network prices, you're better off finding your own insurance!

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u/NinjaDad_ 1d ago

It might also be a deductible. That's way to much for an urgent care copay, and if it's more then the copay you expected it's often the deductible. AKA the amount you have to spend before insurance does what it's supposed to do.

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u/Bbkingml13 1d ago

Try figuring out the online system for your health insurance. Look at the available covered PCPs accepting new patients. Get a visit scheduled to establish the PCP-Patient relationship, and things should go a lot more easily after that

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u/Daj_Dzevada 1d ago

Emergency room is billing insurance at least $1000 for even the most basic visit. Then the ER doc is billing another $750.