Urgent Care could be billed with emergency services co-pay

Insurance companies are warning their customers of a change in billing at area emergency rooms this winter. The change could mean you pay the cost of an emergency room visit, even if you’re receiving Urgent Care services.       

Since Gundersen moved into its new building, they’ve joined Mayo as the only hospitals in the region that have combined their Emergency Room and Urgent Care services into one facility. Because the services share rooms in a building, that often means a smaller wait time, and a professional staff that can decide which kind of care you need. But it also means you could be paying for emergency services, even if you’re at the hospital for a less pressing issue.

At Gundersen, rooms in the emergency services facility serve both ER patients and Urgent Care patients – the service you get may be different, but the location is the same. Theoretically, E.R. patients don’t have to wait for an E.R. –specific room to open up, and vice versa. While that may save a patient precious time when it comes to quick service, it also means you’re paying an Emergency Room co-pay – even if you’re receiving Urgent Care.

Gundersen began the billing system back in January, with the move into its new building – where E.R. and Urgent Care services share a location.

“We started to get feedback from our patients that they were now required by their plans to pay a higher co-pay because of Emergency Room services rather than Urgent Care services,” said Scott Rathgaber, vice president of Gundersen’s emergency services.

Just two months after its implementation, Gundersen is now scaling back the plan.

“At this point the complexity of the reimbursement and regulatory environment right now does not allow us to go forward with our plan, and so in order to serve our patients, we are going back to separating the areas,” Rathgaber said.

Because sharing space between the ER and Urgent Care results in a higher co-pay for patients, Gundersen will designate rooms for each service. Gundersen will make the switch back in the coming weeks.  Once that happens, you will once again pay different co-pays for Urgent Care and Emergency Room services.

News 8 also spoke to Mayo today and how the same situation plays out there. Directors say they use separate rooms for the two different services, except in emergency situations. What that means for patient co-pays is still unclear.

Gundersen will make the switch back to separate space for the two services in the coming weeks.

The co-pay issue doesn’t apply to places where the E.R. and Urgent Care are in separate facilities, like both hospitals’ locations in Onalaska.