The current regulatory gap, if left untouched before the new law takes effect in January, is one that health care experts say could leave patients at risk. Before the surprise billing rules are finalized, the Department of Health and Human Services and three other federal agencies have asked for information on issues such as the frequency of such bills at urgent care facilities and how health insurers contract with the clinics. Regulation varies significantly across states, and data is scarce on how common surprise bills are in those facilities. In July, several federal agencies issued interim regulations that largely would not protect patients from surprise urgent care bills. The Biden administration has expressed an interest in prohibiting surprise bills in those clinics, which may treat serious conditions but not life-threatening injuries and illnesses. Urgent care clinics were not explicitly addressed in the No Surprises Act, but Keller’s experience underscores patients’ predicament ― insurers often try to steer patients to urgent care and away from costly emergency rooms, but individuals could still get hit with large bills in the process. Subscribe to KHN's free Morning Briefing. There are roughly 10,500 urgent care centers in the U.S., according to the Urgent Care Association, which lobbies on their behalf. But one gray area: visits to urgent care clinics, which have proliferated in recent years as patients seek speed and convenience over waiting hours at an emergency room or weeks to get a regular doctor’s appointment. Patients with private insurance will be protected against unexpected charges for emergency out-of-network care, for treatment by out-of-network providers at in-network facilities and for transport in an air ambulance. Under a law Congress passed last year, many surprise medical bills will be banned starting in January. “When you do all the right things, ask all the right questions and you’re still hit with a large bill because of some weird technicality that there’s absolutely no way for you to understand when you’re in the moment.” “It really irked me that, it’s this classic thing you hear in this country all the time,” Keller said. Even in post-accident “delirium,” he said, he asked several times whether the stitches would be covered by his health insurance because it struck him as unusual that a plastic surgeon would do them. “The people at CityMD just said sort of thing is covered as part of an emergency procedure,” said Keller, a regular cyclist who’s lived in New York City for three decades. But it didn’t cover the physician who arrived to stitch his forehead ― an out-of-network plastic surgeon with a Park Avenue office. Keller’s health insurance covered much of the cost of his visit to the CityMD clinic on Manhattan’s Lower East Side. The surprises came fast and hard: a fall that sent his head into the pavement and left him bleeding profusely and in shock, a trip to an urgent care clinic for five stitches and then a $1,039.50 bill.
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