Community Update

Did you think going to Urgent Care would cost less than the Emergency Room? Think again. Patients at Valley Care Urgent Care facilities in Dublin & Livermore Areas are receiving bills for Emergency Room services.

I have come to really dislike Urgent Care facilities and after this I will never use them again despite how convenient it may be . An Urgent Care facility, which is supposed to help keep people out of the far more expensive Emergency Rooms, my insurance has without fail been billed as "Emergency Department" and I have also been sent 2 Bills for a higher copays.
On May 16 , 2013, I accidentally caught the tip of my fingers in my car door causing blood inside my nail . Yes, IT HURT ! OUCH ! But not enough to miss time from work or go to ER. 1 1/2 weeks later on March 24 , 2013, I went to Sutter Heath to see if the Doctor could drill the blood out of my nail but unfortunately Sutter Health was not equipped and suggested I go to Urgent Care rather than ER as that would be more affordable. ( At least that's what we thought) Unfortunately I did not check YELP or BB first and that was a BIG MISTAKE as if I would have read the reviews first I would have not gone to Valley Care. After calling Blue Cross and Valley Care to verify coverage and copays On May 25,2013 I decided to try Valley Care Urgent Care at 4000 Dublin Blvd Dublin,Ca.We verified our Copay multiple times with the Intake lady as she continued to say all I had was a $30 copay during my entire visit { All my co-pays are listed on my insurance card $15 for regular M.D,$30 for specialist,$150 for emergency,$300 for non - Emergency } Why did Valley care choose the $30 copay ? Think about that ! GOOD QUESTION ! The intake lady said "Urgent care takes the specialist rate of $30"I asked if their was any more charges & Valley Care Urgent care continued to tell me that all my copay was $30. So I proceeded with the visit . I seen Doctor Sanwong , Suwich who said there was nothing he could do as the Blood in my nail was dried up I waited to long.He said I should have come in the first 3 days {I waited 10}No Blood was removed.I left disapointed and at check out I again asked what the charges where and She said only the $30 at which time Valley Care collected.

What I received in the mail Three weeks later was a statement of benefits from the Insurance carrier indicating that my time there had been billed as " Emergency Rm Service" with separate charges totaling $1085 .This was followed by a bill on ValleyCare Health Systems letterhead referencing the date of service, and asking for an additional $150 copay. My copay for Emergency Room visit is $150, which was one of the reasons I went to Valley Care Urgent Care. On the website for Valley Care Urgent Care, it even says that using urgent care is an affordable alternative to the emergency room.

The following week in the Mail was another Statement of benefits from my insurance carrier Totaling $354 indicating Pleasanton Emergency Med" Surgery " What Surgery?I had NO SURGERY ! Followed by another bill from Pleasanton Emergency Med Group asking for additional $30 Copay for the Doctor Services Rendered at " Gateway Urgent Care " when I went to "Valley Care Urgent Care" Looks like something illegal possably could be taking place.

I called the billing department phone number listed on the bill and spoke to Vicky about the situation. She was sorry, but there was nothing that she could do about it. Instead, she assigned blame to the insurance company, saying that they must have entered an incorrect code or something .

I called Blue Cross and spoke to a rep about the claim. The rep looked it up and said that Valley Care had billed the May 25 visit as being "Emergency Room service" She explained to me how the coding worked and how she could tell that it was the "billing department's issue" NOT the insurance company. She said that to get this resolved, that Valley Care would have to resubmit the bill with some designation of this being an "Urgent Care" visit with the proper coding. Their was several possible ways ValleyCare could resubmit the claim as Blue cross explained.

I called ValleyCare Gina & Maryann both parroted their clerk and put the fault of the mistakes squarely on the insurance company. I've tried several times to speak with a Supervisor & Left several messages. There was no way that they were going to change the way it was billed.After about the 3rd call to ValleyCare we where FINALLY told By Gina that ANY ONE who enters their facility is charged
" EMERGENCY " with a standard "facility charge" and the Doctor also has a separate charge. That the Intake lady is NOT ALLOWED to disclose that information.They Suggested we file an appeal if we disagree with the fees ( which we immediately filed)They continued to blame the insurance company for the charges.After extensive research & loosing a LOT ! of sleep over this NIGHTMARE ! it is determined to be SOLELY ValleyCare billing issue . It seemed like something illegal may be taking place with billing of the Urgent Care. How many people get over-billed, and then simply pay the bill ? I may quite possibly contact the California Department of Insurance as it looks like a pattern of wrongful billing going on at the facility .We are continuing to fight this wrongful billing and have contacted the news media as we believe their is a story here and this is not isolated incident ( Stay tuned for update)