WIS Investigates: Choosing the right medical facility saves patients hundreds of dollars

(Source: Blue Cross Blue Shield)
(Source: Blue Cross Blue Shield)
(Source: Blue Cross Blue Shield)
(Source: Blue Cross Blue Shield)

COLUMBIA, SC (WIS) - Going to the right facility to get medical treatment not only saves you time, but hundreds of dollars.

Seventeen percent of all visits to hospital emergency departments could be treated at retail medical clinics or urgent care facilities. That could save everyone $4.4 billion annually, according to WellPoint, a health benefits company. There are now more than 9,000 centers in the nation providing urgent care services that average about 357 patients per week per center.

Rising medical costs in the United States have reached a critical state. Total spending for health care reached $2.7 trillion in 2011, according to national health expenditures. This is the result of too many people using the emergency department for non-emergencies. Last year, it cost the healthcare system $4 billion, according to Blue Cross Blue Shield of South Carolina.

"Knowledge is power, as they say, so the more that you know, the better," said Juliana Harris, spokeswoman for the state Consumer Affairs Department. "And you want to do that when you're not in a high pressure situation and you need to get somewhere fast."

At the hospital emergency department, the average wait time per patient is 4 hours, 7 minutes, and the average trip will cost you $1,349. At an urgent care facility, the average wait time is 50 minutes and the bill is $337.35.

"Know your insurance. Know what it covers. Know what the allowed amount is for the certain procedure you're getting is," Harris said. "It's just kind of a good thing to go through your insurance booklet."

Without insurance, some urgent care centers want payment before you leave. The hospital emergency department, however, must treat everyone regardless of their ability to pay.

We researched several procedures using different insurers, but in each case, the urgent care turned out to be an inexpensive alternative.

For example, we found strep throat treatment in the emergency department averages $580 and at an urgent care, it's $90 – a $490 savings. At a retail health clinic, like CVS Minute Clinic, it is $40 for strep throat treatment – a $540 savings, according to Blue Cross Blue Shield of South Carolina.

Bronchitis in the ER is $814 and $122 at an urgent care center – a $692 savings. With Aetna, the cost covered changes based on an individual's health plan. So a minor laceration in the ER can cost an average of $750, while it's $150 at an urgent care. That's a $600 savings.

"You are paying because they have a MRI," said Lynn Bailey, medical economist. "You're paying because they have operating rooms available. You're paying because they're staffed 24/7."

Our investigation also uncovered that not all urgent care centers are the same. While some centers appear to be stand-alone facilities, they could still have ties to a hospital. Those hospital ties can come with equipment fees and additional costs.

"While it may look like an urgent care facility, it might not be an urgent care facility," Harris said. "So make sure what it is before you go in the door."

In the Midlands, Lexington Medical Center has six urgent care centers that are a part of the health system and Palmetto Health Richland has two centers.

"Particularly, if you have a laboratory charge or get an X-ray, you may find you're getting a hospital-based charge," Bailey said.

Some of the retail facilities, like Doctors Care, are in business with insurers. Doctors Care contracts with UCI Medical Affiliates for administration. Blue Cross Blue Shield of South Carolina holds the majority share of UCI stocks.

"You can always ask questions, too," Harris said. "That's something we always encourage consumers to do. If you don't understand the paperwork or you don't understand what you're signing, don't be afraid to go up to the receptionist and ask them what is this and what does it mean?"

Copyright 2014 WIS. All rights reserved.