Urgent Care Centers Want Payers to Rethink How They're Reimbursed

By Leslie Small

On the surface, health plans and urgent care centers should be on the same team, as insurers often nudge their members to choose urgent care over the emergency room for less-serious issues. Yet in a statement issued Sept. 9, the Urgent Care Association (UCA) says it has a major problem with payers: They often refuse to reimburse urgent care centers for providing follow-up care and wellness care.

Laurel Stoimenoff, CEO of the association, says that the main issue is "a disconnect between our reality working in urgent care and what’s being written into contractual language."

"We're either treating people who have no PCPs [primary care physicians], in many cases, or who are geographically displaced from their PCP," she says.

Due to reimbursement limitations, urgent care centers — which typically have more convenient hours and more capacity to treat patients than primary care practices — can't always provide services patients request, like immunizations or physicals, according to the UCA.

America's Health Insurance Plans, though, argues that urgent care can't take the place of primary care. "While urgent care centers are an important venue for care and can be an efficient and cost-effective alternative for an emergency room, for example, they are not [a] substitute for a person's ongoing relationship with their primary care physician," an AHIP spokesperson tells AIS Health.

To Joseph Paduda, a principal with Health Strategy Associates, LLC, health insurers that refuse to reimburse urgent care providers for non-urgent care "are well within their rights to do so."

Yet Fred Bentley, of the consulting firm Avalere Health, says "there is a legitimate argument or question about, why is it that health plans are restricting access and really trying to, in some instances, keep urgent care centers in a box. It’s a really old way of thinking."

From Health Plan Weekly