Exposing hidden fees for ER and urgent care facilities

CHESTERFIELD COUNTY, Va. (WRIC) — When David Silversmith discovered a tick bite one night, he decided to head to the 24-Hour Swift Creek Emergency Room just down the street.

“I went in there at about 11 o’clock at night,” David Silversmith said.

After his visit, Smith was feeling good, on the road to recovery. That was, he felt good until he got this bill in the mail several months later.

Silversmith reads the bill: “It says additional to basic service.”

Silversmith got hit with an after-hours charge at a 24-hour center. The bill notes a $78 fee for service between 10 p.m. and 8 a.m.

“I was pretty shocked, I looked at it, I didn’t understand it,” Silversmith said. “Why am I getting an extra fee when the facility states 24-hour coverage?”

Silversmith complained but was told it’s a normal fee.

“In the past year, we have seen an increase in this code,” says Missy Conley. She’s the Director of Consumer Claims for Medliminal, a medical billing advocacy group. She tells 8News these after-hours surcharges are becoming more common. She’s seen them range from a $29 to $112.

She says it is not just ER’s or urgent care centers which tack on late night fees.

“I had a client in Texas that had a pediatrician appointment on a Saturday and that is where that $112 charge came from, even though it was a scheduled appointment,” Conley said.

Swift Creek ER where Silversmith sought care is associated with Chippenham Hospital and part of HCA healthcare system.

However, the bill came from a contracted doctor’s group, James River Emergency Group LLC.

At first, the doctor’s group told us they do bill for after hours, but it is determined by the billing codes from the hospital.

In what appears to be a finger pointing game, HCA tells us it’s the independent doctor’s group that claims there are additional costs for staffing and equipment overnight. Then in an about-face, a spokesperson for James River Emergency Group, LLC told 8News it was a billing error.

Error or not, according to the American Academy of Pediatrics there’s a whole list of approved after-hours medical codings healthcare providers can add on.

“I don’t think it is right. I didn’t sign anything saying I was there after hours,” says Silversmith.

He says inside the ER, there was no notice of the after hours fee.

8News did some checking and Bon Secours Westchester 24 hour ER does not charge a fee. Nor does urgent care Medexpress.

In a statement, a Patient First spokesman told us this:

“In health care, two ‘open late’ billing codes are recognized: ‘extended hours’ — which are hours of operation usually after the ‘traditional business hours’ of 9 a.m. to 5 p.m., Monday through Friday — and ‘after hours,’ which are times a practice is open past its posted business hours. I can say that Patient First does not charge ‘after hours’ charges,” the Patient First representative said.

Image courtesy of VCU CNS

Bettermed Urgent Care’s hours of business are 8 a.m. to 8 p.m., but if you arrive after 6 p.m. or on the weekend, you get an after-hours fee.

Conley says patients should try to fight it.

It took Silversmith three calls but he finally got that fee removed.

“I am thinking a lot of people are getting this fee and they’re just paying it,” he said.

So what can patients do?  Always ask for an itemized bill of your medical expenses and question any expenses you don’t understand.

Medliminal can also offer help. Learn more here.

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