Followup: West Seattleites sue over Highline urgent-care fee

Last month, we followed up on a long-running discussion in the WSB Forums – about a $100 fee charged by Highline Medical Center‘s Urgent Care Clinic in West Seattle, not covered by all insurance companies, with prospective patients required to agree that they’ll pay it if their insurance doesn’t.

As we reported in that story, Highline’s administrator told WSB the fee is “for the higher costs of operating an urgent care facility during weekends and evening hours, when there is irregular demand for services. …” Adam and Gabrielle Kramer, who first surfaced the complaint, contend that the charge, which they say she had to agree to pay before she could be seen at the clinic for a neck problem last December, violates our state’s law against “balance billing,” and that is the root of the class-action lawsuit they have filed in King County Superior Court (see it here). After Adam Kramer sent us word of the suit this afternoon, we requested comment from Highline, but did not hear back; if and when we do, we will add their response here.

26 Replies to "Followup: West Seattleites sue over Highline urgent-care fee "

  • L April 24, 2012 (10:36 pm)

    Is there a way to join the suit?

  • Nitro April 24, 2012 (10:42 pm)

    My daughters dermatologist is located at Children’s Hospital. When we went for a regular skin check up office visit, we were charged a $250 facility fee (in addition to the actual services provided). Insurance covered the examination, but not the facility fee. Childrens said it was a new policy they instituted 2 weeks before our appointment. Not covered by insurance, so we were forced to pay. Something about them trying to offset costs of uninsured folks using services. Needless to say, we will be changing dermatologists. We cannot afford our copayment plus an additional $250 facility fee just for a check up. I will keep in mind that Highline does the same type of practice, and choose other healthcare.

  • Bonnie April 24, 2012 (11:02 pm)

    Nitro, I posted about this when I got a letter in the mail about it. I called my insurance company (Aetna) and they said it was covered. Needless to say I have not gotten all my bills so I don’t know if it is really covered or not. I’m kind of worried.

  • M April 24, 2012 (11:02 pm)

    Nitro- My UW (Roosevelt Clinic) dermatologist stuck me with that same $250 facility fee last year :(

  • adamk April 24, 2012 (11:25 pm)

    @L: This is a class action suit. In most class action suits the class requires an explicit opt-out, so most probably you’re already in.
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    That said, the law firm is interested in hearing from others who’ve had the same problem with Highline’s urgent care. Contact Matthew Geyman at Phillips Law Group, PLLC: (206) 382-1168 or mgeyman@jphillipslaw.com.
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    @Nitro, Bonnie, and M: I hate to sound like a broken record about this, but the Highline issue is not about facility fees. Highline is deceptively getting patients to agree to be balance-billed. It doesn’t matter that it’s a facility fee, what matters is that they’re balance-billing in-network urgent care patients.

  • CandrewB April 25, 2012 (6:04 am)

    $250 cover charge? An actual routine Derm appointment can’t be more than $150. Think that Derm will be forced to go out on his/her own pretty soon.

  • Bonnie April 25, 2012 (6:59 am)

    Yeah, I know adamk. But Nitro brought it up and I responded.

  • M April 25, 2012 (7:37 am)

    Ditto what Bonnie said.

  • cruzer April 25, 2012 (7:44 am)

    I AM SO GLAD somebody is fighting this unfair policy! Thank you for filing this lawsuit!

  • DebT April 25, 2012 (7:46 am)

    There are costs associated with opting to go to an urgent care facility vs. the emergency room. In many insurance plans, a visit to the ER is fully covered, but a visit to an urgent care facility is not. If insurance companies don’t cover the visit and patients don’t agree to pay the balance, then how can any business stay in business.

  • Michelle April 25, 2012 (7:48 am)

    This is so shady. I have BCBS for insurance and go to Highline for primary care. I was very excited to hear about the Urgent Care Center and went there one evening when I cut my finger badly. I showed up and was seen pretty quickly once they saw I was bleeding, asking me only to fill out a piece of paper with my name, birthdate, and social (I think). They asked if I had insurance on file and I said I did.

    I got stitches pretty quickly, and the ARNP told me to return in 10-12 days to get my stitches out and that the second visit would be included in the cost of the first. I returned on day 11, and was in and out in 10 minutes.

    Two weeks later, I got a bill for $300, $150 for the first visit and $150 for the second visit. My insurance covered up to a $50 co-pay, but would not cover the additional $100 (x 2) charge from Highline. I called Highline to ask, and the manager informed me that I was supposed to return within exactly 10 days, and because I didn’t, they charged me a second time. She also said that I was supposed to have the same nurse to both put in my stitches and remove my stitches.

    I explained that I didn’t know that either of these rules existed and she finally agreed to remove the charges for the second visit “out of a courtesy” to me. SO shady.

  • adamk April 25, 2012 (8:18 am)

    @DebT: One of the major benefits of insurance is collective bargaining. If medical facilities could turn around and bill a patient for additional money, it undercuts that benefit. That’s why it is codified in contracts between insurance company and medical facility as well as state law: you cannot bill the patient separately while also billing the insurance company.
    .
    When you say “If insurance companies don’t cover the visit” you’re referring to a visit to an urgent care that has a contract with a given health insurance provider in order to provide these services. They do, by definition, cover the visit. I’m not referring to out-of-network care, where balance billing is more common and legal.

  • JoAnne April 25, 2012 (8:23 am)

    Either the facility will prevail in this lawsuit or they will end up shutting down their emergency services, and probably the latter.
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    You can’t endlessly serve uninsured people with no consequences.
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    Remember, we are a sanctuary city. Uninsured people come here knowing they will never be held accountable to pay for services they use, medical or otherwise.

  • Sue April 25, 2012 (8:27 am)

    DebT, if a facility can’t afford to stay in business due to fees not being covered, then that’s something they need to negotiate with the insurance companies – not stick it to the patients. When I use my insurance, my insurance company has negotiated a certain rate with the facility, and they are not allowed to balance bill. And visits to the ER are not fully covered in anybody’s plan that I know of: I pay a $100 copay (unless admitted), and then you have to hope the dr. and techs are all actually covered by your insurance, and there are additional fees for medical tests. A visit last year to Swedish ER cost me $500 last year ultimately after an injury, for an exam and x-rays – that was just my out-of-pocket cost. Had I been able to go to an urgent care, it would’ve cost me my regular $25 copay (plus a small % of the x-rays).
    .
    I’m glad also that someone brought this suit. I live just a few blocks from this urgent care, and would rather take my chances at the ER than deal with their policy. I think the worst part of all of this is that people usually don’t go to urgent care for routine visits – they go because they’re having a medical issue that can’t wait. You probably then don’t have the luxury of just going somewhere else because the fees are too high: you need medical care now, otherwise you would’ve just waited for your regular dr. So it just seemed like people in a desperate situation were being taken advantage of and backed into a corner.

  • Gene April 25, 2012 (8:53 am)

    As a FYI – the “Facility Fees” are also charged at places like the UW Medical Center — and apply even if your doctor/specialist only uses that facility for their “office.” Basically, if you go to the doctor in a place called “urgent care”, or if the doctor has their “office” in a hospital, or hospital-like facility, (as Nitro found out), check for and be prepared to pay extra – sometimes significantly.
    .
    The whole health care (“sick care” anyway – since it has little to do with health) is busted, focuses on the wrong things, and is way overpriced compared to most other countries.
    .
    Sustainable West Seattle had a great health care forum a couple months ago, I wish it had been recorded. I’ll have to see if the main speaker has recordings of his other talks available.

  • WSratsinacage April 25, 2012 (9:09 am)

    Thanks for fighting this!

  • adamk April 25, 2012 (10:49 am)

    @JoAnne: Your comment is inaccurate. Highline’s Urgent Care facility does not provide emergency services. They’re not an ER, and as such have no obligation to provide medical services to anyone. If you show up in need of emergency services, they’ll call an ambulance.
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    @everyone else: Thanks for the support. The only way we can keep from being repeatedly taken by bad business practices is to stand up for our rights. I’m trying to do my part, after Highline refused to be reasonable.

  • A April 25, 2012 (12:17 pm)

    Went there a few months ago and they told me that there might be a $100 charge that my insurance wouldn’t cover. I have good insurance so I said ” that’s fine” thinking it would for sure be covered by my insurance since they have always covered everything except co pay obviously. Got a bill in the mail for $150 from highline and was quite surprised my insurance didn’t cover that fee I was told about. Nonetheless I paid that bill. Was very surprised when a few weeks ago I received a check from highline for $100 stating it was a refund check for an overpayment on my behalf or a duplicate payment by myself and my insurance. I was happy to receive the refund and that I have good insurance but now I’m upset that highline was doing something shady and trying to take my money. Didn’t get good service there either so probably won’t be going there again.

  • EN April 25, 2012 (12:23 pm)

    Thank you!!! Is there a way to join? The billing staff customer service is beyond terrible. I posted my review on yelp about my terrible experience with their billing department and it was promptly deleted. Do patients really not have any voice against these practices? My insurance company told me that an ER visit would have been cheaper. The ER is what is was trying to avoid, but I guess I learned my lesson the hard way. My condition truly was urgent, and it doesn’t seem ethical to do this when anyone is seeking care for an URGENT issue.

  • bsmomma April 25, 2012 (1:25 pm)

    When someone I know went to the Highline Urgent care (they are uninsured due to loss of job) they required $150 CASH up front before being seen. So not sure how this can be a case of making up for uninsured folks not paying up.

  • JoAnne April 25, 2012 (2:57 pm)

    Adam it is true that a clinic or urgent care center is different from a full-scale ER in that it is less expensive to operate.
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    However, virtually all hospitals AND clinics are subject to EMTALA. They can send patients somewhere else to be treated, but they can’t refuse treatment because of immigration status or inability to pay.
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    Indigents and illegal aliens are not stupid when it comes to getting free stuff. They know all about this, and they are most definitely using these facilities.
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    We are all paying for this one way or another through higher premiums, copays, taxes, additional fees, etc.
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    I am sorry about it, but this is part of the health-care reality now. Think of it as your contribution to social justice.

  • Seattle April 25, 2012 (3:26 pm)

    JoAnne, this is not really a case about serving uninsured people or even about medical providers charging a facility fee.
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    What Highline is doing wrong is 1) their lack of transparency re: the $100 fee and specifically the insurance companies that will cover this extra fee ( virtually none) 2) the fact that they are trying to balance bill patients.
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    It is my understanding that this is both unethical and illegal, thus why Highline is currently being sued.

  • tk April 25, 2012 (9:39 pm)

    Group Health also charges an extra $97 “facility fee” if you use their urgent care at Capital Hill. This is in addition to the provider fee. When questioned, the business office said that it is “required by state law” to charge the facility fee because the urgent care is co-housed with a hospital, and “the billing codes” require an additional facility fee.
    Strangely, they say that at their urgent care facility in Bellevue, you would not be charged the facility fee, because the hospital is actually “across the street” and not physically connected. So, next time, I guess we drive further to save 50% on the same exact medical care that we would recieve at a closer location. Absurd!
    (does any one know what state lwa they would be referring to?)

  • Sharonn April 26, 2012 (7:08 pm)

    You need not drive very far, just down Alaska Street to 37th to see Dr. Terrell Harrington. His practice is open late, his staff are so friendly and he’s a local highschool team doctor! A community minded, friendly physician with a great staff. Next time just call his office at 206-362-8674, drop in and be sure to check out his website at myfamilydoctorws.com. I can’t afford $400 for someone to tell me I have a cold so here’s an alternative.

  • MaryCooks April 26, 2012 (8:45 pm)

    Dr Harrington is so awesome. If you are uninsured he charges $100 and they always be sure to tell you to go to QFC which surprisingly has the most reasonable pharmacy prices. I have high praise for Dr H!!

  • Ellen May 1, 2012 (9:02 pm)

    I went to the Urgent Care facility yesterday feeling so dizzy and dreadful and was treated with such great care. I was seen by Emilie Lowens and was delighted with such swift and great care! I am happy to pay an extra $100 to feel so much better….even though I pay insurance every month…I hardly ever use it as I mostly use alternative medicine which as you know is hardly ever covered.
    Thanks for the great care! May we all find a peaceful and practical solution to the endless healthcare crisis we are all affected by in the US today!

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