Urgent care, freestanding ER or hospital? How to choose
AUSTIN (KXAN) – When Kathy Gassman’s dog, Sophie, has to go outside to do her business, she has to go.
Even if it’s in the middle of that brutal ice storm at the start of 2023.
“It was the ice storm of Jan. 31,” Gassman recalled.
When she opened the back door to let Sophie out, Gassman slipped on some ice on the patio.
“Boom, I went right down,” she said. “I still opened the gate for the dog and I went in to see what was happening with my body.”
Gassman’s right wrist and left foot were hurting.
“So, I went to this freestanding emergency place, which I thought was like an urgent care,” she said.
It was called the Brushy Creek Family Hospital, and it's just minutes from her house in Round Rock.
After a quick exam and a couple of X-rays, the prognosis from the doctor she saw and the radiologist who read her X-rays was that nothing was broken. So, with tape around her toes and a bandage on her wrist, Gassman went on her way.
Days later the bills came. One was from the doctor, another from the facility.
“I’m like, that’s outrageous,” she said. “It was over $10,000."
What Gassman didn’t realize is that the facility where she went was not an urgent care or a freestanding emergency room, it’s actually a hospital, just on a smaller scale.
“I had no idea,” she said. Even though she did sign a form that day stating she was in a facility that was part of a group of freestanding ERs and hospitals.
“When you’re signing off on things, you know, do you read every fine print? No. And I didn’t. I probably didn’t,” she said.
Urgent care versus freestanding ERs & hospitals
“It’s certainly confusing,” said Dr. Diana Fite, an emergency physician and past president of the Texas Medical Association. Between urgent cares, freestanding ERs and small, neighborhood hospitals, she said, “it’s a hard decision to make for the general public.”
Fite said urgent cares are not state licensed, have limited services, do not stay open around the clock and are not required to have doctors and nurses on staff. Instead, they may have nurse practitioners or physician assistants.
Urgent cares are typically less costly than freestanding emergency rooms and small hospitals. Those have rates similar to a traditional ER or hospital visit because they provide a higher level of care with 24/7 operations and are state regulated with certain mandates.
“They have to have nurses there, they have to have physicians, ultrasounds, cat scans, all sorts of medication. There’s all sorts of requirements than an urgent care type of place is not going to have,” she said.
Dr. Nathanial Greenwood is the chief medical officer for Brushy Creek Family Hospital where Gassman went.
“As an industry, we’ve done our best to educate people,” he said.
Gassman gave Greenwood permission to speak with KXAN Investigates about her case. Greenwood said his smaller hospital with an ER still has full-size hospital prices because it’s open 24/7 with doctors and nurses on staff and has two operating rooms and in-patient beds for longer stays.
Despite what the bills state, Greenwood explained they typically expect to get only a fraction of what they charge.
“We send essentially an inflated bill and realize that the insurance company is not going to pay anything close to that,” he said.
As it turns out, of the $10,436.38 amount charged between the two bills, Gassman’s insurance agreed to pay less than 10%, a total of $950.52. It’s an amount Gassman would have to pay out of her own pocket because she hasn’t met her insurance deductible.
Gassman still thought the amount was too high, so KXAN Investigator Mike Rush connected Gassman with Dr. Greenwood from Brushy Creek Family Hospital.
They agreed on a charge of $181.55.
Gassman's advice to others is to do what she didn’t do.
“Read signs, ask maybe questions before you start filling things out,” she said.
How to decide where to go
According to the Texas Association of Freestanding Emergency Centers, urgent cares are good for treating things like minor infections, flu symptoms, sprains and small cuts.
Freestanding emergency centers are equipped for issues like a heart attack or stroke, open fractures, head injury or severe bleeding. Greenwood said small hospitals with emergency rooms have the same capabilities.
And if the facility has the word "emergency" in the name, expect to pay premium prices.