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In our agency dealings we come across a lot of “gotchas” in many parts of the employee benefits picture. Whether our clients are individually enrolled or are part of employer based plans the surprises are very similar. Here are the latest unpleasant surprises we have run into:

  1. Many of us are not clear about non-emergency use of the emergency room, so let’s be sure that we go there only when there is a life or limb threatening issue. Otherwise we may well find ourselves responsible for a bill that can run into MANY hundreds of dollars.
  2. Recently we discovered that at least one of the major insurance carriers has applied the same rule to non-urgent use of an urgi-care facility. It is unclear to us how this will be decided, but it would seem that coding at the facility at the time of service is critical. Many of us have used urgi-care facilities for what we determine to be “urgent”, but it seems we need to determine if care could be provided adequately at a convenience care facility. If a Minute Clinic at CVS or a Healthcare Clinic at Walgreens might be considered adequate we should consider care there first. Some free standing clinics have primary care services so we assume that those will still be fine to use for non-urgent care. Let’s just identify those that are clearly Urgi-Care facilities and access them judiciously.
  3. A few months ago my husband went to an Urgi-Care facility which was clearly in our network list. To his surprise his credit card was charged the full amount of the urgi-care visit without a network discount. It took us SEVERAL phone calls to straighten out the billing by proving that the care was appropriate and that the copay was the only fee owed.

These are some recent observations in the urgi and emergency care arena that we wanted to share with you. We all need to be vigilant about where we access care as the penalties and hassle for incorrect use of facilities is increasing constantly.

For assistance in figuring it all out, contact us at Czajkowski Dumpel & Associates, Inc. – We are here to help!