Urgent Care Medical Offices: How do They Work?

What Is the "Urgent Care" Medical Office?

In theory, this type of medical office is supposed to bridge the gap between your primary care doctor and the emergency room. You can visit an urgent care center for non-life-threatening matters that require more immediate treatment than are usually available within the appointment time frame to visit your regular doctor.

Notice I said, "in theory." Theories are wonderful, but in practice, do not often live up to their promise. As an aunt of mine used to say, "Paper is patient." Her meaning was that you can put any old idea you wish down on paper, and the paper won't complain or point out the flaws.

The flaws with the so-called "urgent care" system are many. The following story is absolutely true, and was inspired by another hubber's also true horror story of her experience with this boondoggle. (A link to her story appears in the sidebar below.)

Back In Time to June of 2008

My husband and I were out of town at a car show in which we were participating. There was a good deal of extra "baggage" in the form of a sun canopy, and the extra items for our show display. It would not all fit into our "show" car, a small PT Cruiser, so we had loaded it into our truck and driven both vehicles.

On the way back to the hotel between the daytime and evening segments of the show, an inattentive 20-something driver used the front wheel of my truck for her brakes, pushing me sideways a good 10 feet from where I was already in my turn. It is the worst possible place to hit a vehicle. The impact totaled my truck, crumpling up the passenger-side floorboards, bending the frame and tweaking the engine 15° off center on its mount.

The truck was a model made prior to side-airbags, and seat belts do not hold you in place against a sideways impact. I was tossed sideways against the driver's door, and sprained my wrist. Police and paramedics both showed up; our truck was towed, and we had to stuff-cram all of the extra stuff into the poor PT.

It was bad enough that this had happened, but this was also a mini-vacation; our first get-away in several years. I declined treatment at the scene, as I did not want to have the entire trip ruined by sitting for hours in a strange emergency room and miss the rest of the show. So, I managed to wrap the wrist, jury-rig an ice pack, and continue on.

As small consolation, the next day at the awards ceremony, we found we had won first place in the show-and-glow nighttime segment, and I got a very lovely trophy as a "hardship award," an annual presentation given to any participant who had arrived at or continued on with the event under difficult circumstances. Whoop-dee-doo!

After We Got Home...

As I was then a victim of my county's free, so-called "basic health care system," I was not covered for any treatment, whether emergency or not, outside my home county, and even there, I was only allowed the county hospital; they wouldn't cover any of 3 that are much closer to where I live.

Since my wrist was still paining me, and in fact feeling worse, my auto insurance had told me to just go to Urgent Care. I knew they would pay, even though the county would not. So, I called my daughter to drive my husband and I over to the "urgent" facility, as our car was still crammed full.

Upon arrival, I explained why I was there, needing an x-ray to be sure I had not broken the wrist. Their answer was to inquire whether I had an appointment! Excuse me?? Now, I don't handle pain well, and by this time, a day after the injury happened, I was feeling more than a little bit testy. I informed them in no uncertain terms that my injury had not made an appointment, and that my auto insurer had told me to go directly to urgent care, and that I was not going anywhere until I was seen.

They finally relented under my evil stare, and booked me in. We sat in the waiting room. And sat. And sat. And sat. When we were done sitting, we sat some more. All told, it was nearly 3 hours before we were finally called into see a doctor. Once in the exam room, the nurse did all the usual blood pressure, temperature, etc. I was in a nasty mood by then, and acidly told her that I had sprained or broken my wrist, which does not cause fevers. We waited at least another half hour before the doctor came in.

From Bad To Worse

Once the doctor arrived, poked and prodded a bit, she then informed me that they couldn't send me for x-rays because their partners in the building did not accept "third-party" payments. I went through the roof. I told her they would be paid directly by my insurance, and that my insurer had told me that their payment system was considered a first-party payer.

They were adamant, and the doctor informed me there was nothing she could do but refer me to the emergency room anyway. I lost it, and told them in no uncertain terms how dysfunctional their entire system was. I think the doctor was somewhat intimidated, as she brought in their "counselor" to try and 'reason' with me. They underestimated the extent of my ire. There was going to be no 'reasoning' their way out of this boondoggle. I insisted that I had not sat around for over 3 hours to end up with a refusal to treat.

Since they had offered to wrap the wrist and give me some over-the-counter type pain medication, they tried to argue that it was not a 'refusal to treat.' I looked them square in the eye, and said, "You are not offering me what I need, which is an x-ray, and you are not offering any further treatment than I can do for myself at home, so yes, it is a refusal to treat." I finished off this sally with, "Don't try to argue semantics with an English major!"

With that, I stormed out of the office, and as I exited the waiting room door to the parking lot, I called back at those unfortunates still in the waiting room, "Go home! You're wasting your time--they won't help you here!"

The Nerve--The Brass Nerve!

For all of my, my husband's and my daughter's wasted time; for their refusal to treat me, they had the nerve to send me a bill of over $300. You think I had gone through the roof when I was there in person? Oh, baby, you hadn't seen anything yet.

I went back and forth with them for one round on the phone, and one round by letter, explaining that I did not have the ability to pay that amount. They then sent another bill anyway.

Do you know how I finally handled that major mistake on their part? I back-billed them for our wasted time,making sure that my bill was bigger than theirs. I spelled out my daugher's hourly wage, her wasted time, and I listed our hourly rate as if we had still been working at our handyman service (the principle of the matter, if not the fact of the moment). After all, wasted time is wasted time, and time, as they say, is money.

I told them in no uncertain terms that since I had not been treated, they were not getting a penny out of me, and in fact I considered that they owed me the amount itemized in my back-billing. I ended the letter saying that they could either pay me my demand, or drop the matter entirely and call it even. It worked. I never heard from them again.

The Final Solution

After storming out with my blood pressure through the roof, we went home and had a bite to eat, after which I did end up going to the local emergency room anyway, where I sat for another 3 hours before I was called in.

They did x-ray my wrist. They did give me a couple of injections for pain and sent me home with another prescription for further pain. They did confirm it was just a nasty sprain, and provided me with a brace. They did accept my auto insurance as payment.

I learned that "urgent care" is anything but, and I learned why emergency rooms are so overwhelmed with non-emergency cases. Why go through all that, to end up not getting help, when you can walk into any ER, at any time of day or night, no appointment needed, and actually get help, money or not, insurance or not.

Our health care system is beyond broken. It cannot be fixed. It needs to be totally scrapped and a new system started from the ground up.

© 2012 DzyMsLizzy

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Comments 12 comments

DzyMsLizzy profile image

DzyMsLizzy 22 months ago from Oakley, CA Author

Hello again, suzanne,

The emergency room is a far different animal from an 'urgent care' clinic. They are usually more geared to serious injuries (such as broken bones), or sudden, life-threatening illnesses such as heart attacks.

However, that system does get abused and clogged by people who do not need to be there. When I finally ended up in an emergency room for the fiasco described in this article, I waited 3 hours because there had been an auto accident they were dealing with. But even there, I witnessed some out-of-sequence things happen, that should not have. When I arrived, there was a mom and dad with a little boy who had a pretty good cut on his forehead. There was another kid that was obviously only suffering from the common cold. They took the kid with the cold first, and I thought they should have taken the kid with the cut on his head!

At this point, some reforms have been made, but more still needs to be done. Thanks much for sharing your story.

justmesuzanne profile image

justmesuzanne 22 months ago from Texas

I had never heard of urgent care clinics until I broke my wrist recently. My neighbor suggested that I go to one, but I never did make it that way. What my own experience taught me is that I will not go to the emergency room again if I can help it. They were very nice, and it was a fairly pleasant experience, but it was basically a waste of time and money. They just performed triage and put me in a temporary splint and gave me a referral to the tune of some $8000. If I had it to do over again, I would go to my general practitioner for a diagnosis and a referral and skip the $8000 temporary treatment.

DzyMsLizzy profile image

DzyMsLizzy 4 years ago from Oakley, CA Author

Hello, Christine--

I'm sorry to hear that your sister had a rotten experience, as well. Perhaps is she is willing to share her story as well, then this grass-roots approach is a better fix than the slow-moving politicians with the insurance companies and "Big Pharma" dropping constant bribes into their back pockets.

If you tell her tale, I'll link it to mine, and mine links to the original hub I read, and she is linking to other similar stories--and that, my friend, is how it's done.

Thanks so much for the votes!

DzyMsLizzy profile image

DzyMsLizzy 4 years ago from Oakley, CA Author

Hello again, seo guru--so, you are saying that because a medical doctorate costs half a million bucks, the doctor should expect to charge exorbitant rates and attempt to get rich off of each and every patient?

You are suggesting that a patient should go to the emergency room, even for a non-life-threatening emergency and further clog that system, the original intent of which was to treat serious injuries and sudden illnesses like heart attacks, and not snot-nosed kids with a cold or scraped knee?

Your comparison with Wal-Mart is apples and oranges, sir.

When I went to the doctor's office many years ago for removal of a small cyst from my finger, they billed me $5 for a simple band-aid that I could have gotten for myself for a couple of pennies. That, sir, was many years prior to any so-called "government reform," so, no it is NOT the so-called reforms that are driving prices. Being "for profit" is one thing. Being greedy and charging prices that essentially tell the poor to "go away and die because we can't be bothered with you" is quite another.

This discussion is closed. I will not debate the matter further with you.

Christine B. profile image

Christine B. 4 years ago from Medina, Ohio

I know we ALL have nightmarish stories about waiting to be treated in an ER or in an Urgent Care Facility, but after reading your article, I'll take the ER at my local hospital, thank you. My sister and her husband have a similar story to yours with an Urgent Care facility. I cannot understand what their point is, especially if you have to make an appointment. What a crock. I would have been just as irate as you were, my friend. Maybe your best revenge is writing this article and warning others of their lack of concern for their patients. Good Job! Voted Up and Useful! :o)

seo guru profile image

seo guru 4 years ago from Chicago Area

I see so what you are saying is a Doctor who sells his product or service (Health Care) in a for profit business, should give it away to people who can not afford it. Even though he has to pay his staff, rent, insurance, equipment, and other overhead costs. Even though he spent roughly $400,000 to get the degree to go into that business and probably owes a couple of hundred thousand dollars of it. He should hecause you chose to go to a for profit center, to tell all his creditors and staff oops I can't get paid so you won't either.

You have to think logically, you have to understand there are factors not under the control of a provider forcing them to have to take actions to protect themselves. Again it was your choice to go to that facility and had they told you at check in their policy you could have chosen to stay to leave.

Do you know that doctors incomes declined 30% over the last two years. Do you know doctors borrowed ten times more money in 2011 to cover their practice (or Urgent Care) operating expenses in the last year than the year before. Do you know that a record number of doctors filed bankruptcy, retired, closed their practices. Do you know that 60% of all doctors now work for large systems. And are you aware there is projected to be a shortage of doctors by about 45,000 in the next 8 years. You have to take some responsibility. You could have gone to the ER, you could have asked what the payment policy was before sitting there. These facilities are not charity care facilities, they are for profit businesses. Would you go to Walmart not expecting to pay for the items purchased at the time you left with them. and by the way your government health care reform is driving most of these radical payment challenges.

DzyMsLizzy profile image

DzyMsLizzy 4 years ago from Oakley, CA Author

Hello again barbergirl--

So true about stupid ER visits. I honestly think SOME people go only because they are lonely and want someone to talk to..so they go sniff up some pepper or something to make them all sneezy, and waltz into the ER with a "bad runny nose" etc...

barbergirl28 profile image

barbergirl28 4 years ago from Hemet, Ca

Ha ha - yes.... I think Hub would have cut your comment down to a readable length in the comment section if you would have gotten all that in the comment section. But it works... you were able to write your story... and then we can connect the two making for even more exposure.

People definitely need to learn the proper usuage of the emergency room. My husband works in one and he has seen so many cases of ridiculousness coming in... it is horrible. The worst thing is... a lot of these same cases are the ones who the taxpayers pay for their visit so they don't seem to care.

BTW - I love your moms saying... it really makes it sink in doesn't it... Now if only this 7 day cold would finally pack it's bags and leave. It's been around for awhile! LOL

DzyMsLizzy profile image

DzyMsLizzy 4 years ago from Oakley, CA Author

Hi, barbergirl28--

Thanks for checking in. You see why this would not have fit into/been appropriate for a comment box. ;-)

The Occupy movement has the right idea. OCCUPY EVERYTHING! If that's what it takes to make a problem visible, then so be it.

On the other side of the coin, some of the problems are, indeed, caused by dodos using the ER for a common cold. If you have a cold, stay the F** home...and just deal with it. You don't need a doctor. As my mother used to say, "A cold will be over with in a week if you treat it, and 7 days if you don't."

barbergirl28 profile image

barbergirl28 4 years ago from Hemet, Ca

Totally with you on that one. I think the doctor's offices need to make sure they have enough room to offer services for those that are sick.. the occasional cold or ear infection... those things don't need to be treated in an Urgent Care or emergency room. It clogs the system. Yet, they seem to be booked until further into the month. Ok - by that time the cold will have either left you miserable or have done some real damage.

I am sorry you had to go through this... but at the same time, I am happy to know that I am not the only one that thinks the system is broken. And I like your tactic... maybe we should be billing the Urgent Care for our wasted time as well and maybe they will understand their lack of treatment!

DzyMsLizzy profile image

DzyMsLizzy 4 years ago from Oakley, CA Author

Hello, seo guru--

You are quite right--I don't want to hear it. There ARE NO EXCUSES for the way things are currently set up.

First, the number of patients they see; patient "loyalty," etc. are brought on by the very flaws in the system.

Next, NO ONE should be "out of network," because there should be NO "networks." The insurers should have NO right to dictate where a patient may be seen, or by which doctors. This whole idea of "contracting with" a given insurer is a major cause of these all problems.

"Cash basis" does not work for the poor. And urgent means urgent. Discrimination based upon income, and doctors choosing to reject patients they "don't want" because they are poor is a shocking and unacceptable condition in this society, and in my opinion, an outright violation of the Hippocratic Oath--refusal to treat because of being poor IS DOING HARM.

"Simply agreeing to pay the bill..." Right--are you volunteering to front the money? I didn't have it. You can only be reimbursed for what you have the money to pay out in the first place.

I don't mind paying for services rendered, but I'll be darned if I'll pay for being treated like a piece of second-hand trash, and having not a single thing done. I'm not going to pay for something I did not receive.

So your comment that, "...so many people and insurance companies do not pay for the services provided and the providers have to protect themselves..." comes off as sounding rather condescending at best. It is also a perfect argument for a single-payer system. Our government CAN afford to provide medical care for all citizens, IF they simply stop spending money on stupid things--of which there are too many to name here.

The system, as I said, is beyond flawed--it needs to be re-invented, for it cannot be "fixed."

Thank you for taking the time to respond with an obviously well-thought out comment. I am sorry that in the end I cannot agree with your assessment.

seo guru profile image

seo guru 4 years ago from Chicago Area

I know that you don't want to hear some of what I am about to write but it may help you understand the issues you had. I am not condoning them but there are reasons you experienced them and they could have been solved by telling you up front that they do not bill the insurer for you.

Now that said here is the challenges your urgent care faces, and one stat first Urgent Care Centers treat 150 million patients a year.

Okay so the issues you faced

Many urgent care centers do not contract with an insurance company so you are considered out of network, Insurance companies delay paying these claims, drag out the process and make the whole effort to bill them by the center a challenge.

Many centers are a cash basis center because patient loyalty does not exist, many are just one and done (patients) and many are the uninsured, who if they went to the emergency room, they are required by law to treat them regardless of the ability to pay, whereas the Urgent Care Center is not so required, so they don't want those patients.

If you had simply agreed to pay the bill, even at the time, you personally could have filed the claim with your insurance and been reimbursed if your deductible had been met. It it wasn't met you would have paid for the visit regardless and even if they processed the claim you would have been billed for the visit in the end.

So while your experience was difficult, the reasons behind it is so many people and insurance companies do not pay for the services provided and the providers have to protect themselves.

I agree the system is flawed and mainly due to government regulation and insurance company payment requirements.

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