WCVB
By: Ben Simmoneau
Patient says experience raises questions about medical billing at one of the region’s largest health care providers.
FOXBOROUGH, Mass. — The sign said urgent care, but the bill didn’t. A local man says a recent visit to urgent care left him with some pressing questions about a surprising billing practice from one of the region’s largest health care providers.
Back in March, Rich Coulombre wasn’t feeling well, but his primary care doctor was on vacation. He turned to the Brigham and Women’s Urgent Care at Patriot Place in Foxborough, which wasn’t far from his Medfield home.
“Pretty much the first thing they said to me was, ‘We are urgent care, but we don’t bill like urgent care,’” he said. “This struck me as really unfair and misleading.”
Needing the medical treatment, Coulombre proceeded with the visit but then started wondering how much it might end up costing him. In the urgent care lobby are multiple signs warning patients of added costs including a hospital “facility fee” and possibly a specialist copay. The signs also say the visit may require a referral for insurance purposes.
“If you’re not going to bill as urgent care, don’t call yourself urgent care,” said Rich Coulombre. “I do absolutely think this is about money.”
Deirdre Cummings is legislative director at MassPIRG, the nonprofit Massachusetts Public Interest Research Group, and runs their public health and consumer protection work.
“That’s a bait and switch,” she said. “You can’t put up a sign and say you’re one thing and then when somebody shows (up at) the facility, you tell them you’re something else.”
Cummings believes the signage in the lobby isn’t adequate for a prospective patient to figure out their true out-of-pocket cost, especially since they likely have an urgent need for care and are unlikely to go elsewhere.
“It takes a lot of research to figure out, well what does my insurance cover? What’s the copay? What’s the co-insurance? And how’s that going to work?” Cummings said. “You usually have to figure that stuff out ahead of time.”
She believes it’s especially problematic for a facility like this to charge a hospital fee, which is supposed to help cover extra costs unique to hospitals.
“Like being open 24/7, having access to specialists, all the things you might expect in a hospital,” she said. “Consumers are left holding the bag in this situation where insurance companies will say, ‘Well, we’re not going to pay that.’”
Both of the two bills Coulombre received are labeled as a “hospital visit,” and he was charged $169 for the hospital facility fee. That fee was covered by his insurance, as were the vast majority of the $1,284 billed for the visit. He thinks that’s because he flagged the claim for his Medicare Advantage plan as soon as he was feeling better.
“I definitely rattled a few cages. I filed a grievance with my insurer, saying this doesn’t feel right,” he said. “And they agreed.”
A Brigham spokesperson said they understand this can cause frustration, but added it’s on patients to do research before seeking care. Several urgent care centers under the Mass General Brigham umbrella bill differently — some as hospital visits and others as doctor’s offices. In this case, the spokesperson says it’s because this urgent care at Patriot Place existed before insurance companies created a special coverage category for urgent care.
“This care center, part of our Brigham and Women’s Hospital complex at Gillette Stadium, is a Brigham and Women’s hospital-licensed facility,” said the spokesperson in a statement. “Staffed by Brigham and Women’s Hospital clinicians, it offers academic medical center urgent and immediate care, along with other services, and is billed accordingly. In this case, as with all others, we ensure transparency in billing by informing the patient during registration before they receive care, providing a brochure, displaying literature in our waiting room, and featuring information prominently on our website.”
Coulombre says he spoke up to warn others who might get hit with a big bill.
“I don’t like when people pretend to be one thing and do another,” he said. “It was the fundamental unfairness of their approach to getting business.”
