ER choices increasing as new centers open

Consumers need to understand how their insurance works to make the right decision, said Vickie Johnson of CareNow, a Coppell-based urgent care chain that has been operating in the DFW area for 20 years.

"Your insurance is going to drive where you can and cannot go," she said.

For example, as with urgent care centers, some freestanding ERs may accept Medicaid and Medicare, but others do not.

Emergency medical center

Freestanding ERs and urgent care centers don't admit patients to stay and might not accept Medicare or Medicaid, but the small Baylor Emergency Medical Center opening next year in Colleyville will do all three.

Emerus Hospital Partners LLC, a company based in TheWoodlands, is partnering with Baylor on the center and several more.

The 20,000-square-foot center at 1187 Church St. will have eight inpatient beds, a seven-bed emergency room and a triage room, said Rachel Hedstrom, spokeswoman for Emerus.

The hospital will be in-network for all the same insurance policies as Baylor, said David Stillwell, Emerus' chief operating officer. In-network providers have a contract with an insurance company for pre-negotiated rates that typically are much lower than out-of-network rates.

Stillwell said the center will have a patient relations team to advocate for patients and help sort out insurance concerns.

Although state law mandates that all emergency claims be paid at an in-network rate, Stillwell said insurance companies may not agree that a visit was for an emergency. He said the team can help patients with those kinds of issues.

He said consumers with high deductibles should remember that, in addition to a co-pay for an emergency room visit anywhere, they may also be responsible for the deductible and for co-insurance, which can be 20 percent of the bill, even in-network.

The partnership has opened one emergency medical center in Aubrey and plans to open more in Keller, Murphy, Rockwall, Burleson and Mansfield before the Colleyville hospital opens in August 2014.

Freestanding emergency rooms

First Choice ER opened a freestanding emergency room earlier this year at 5000 Hwy. 121 in Colleyville. It is open 24-7 and accepts all major insurance carriers, but is not recognized by Medicare or Medicaid, spokesperson Claire Gibson said.

The first location opened in 2002 in Flower Mound.

Like urgent cares and the Baylor Emergency Medical Center, First Choice emphasizes convenience and speed. For instance, a comparison chart on its website says it delivers preliminary radiology reports, such as X-rays and CT scans, in 30 minutes.

The FAQ on the website says patients may see a facility charge on their bills, and may be charged more than the co-pay depending on deductible, co-insurance and covered services.

Another freestanding clinic, Complete Emergency Care, is planned at 321 W. Southlake Blvd. in Southlake. Its goal will be to see patients within 15 minutes, said Robert Morris, administrator and partner, at a Southlake City Council meeting. He could not be immediately reached for further information.

The clinic is to include six examination rooms and a treatment room.

Unlike urgent cares, freestanding emergency rooms have been regulated by the state since 2009.

Urgent care and others

In Colleyville, Dr. Kevin Wacasey has opened Colleyville Medical Clinic at 6400 Colleyville Blvd., which is not geared specifically to emergency care, but has weekend hours and maximum wait times of 15 minutes.

The clinic does not file insurance or accept Medicare or Medicaid, but offers low rates for services such as immunizations.

While their physicians must be licensed in the state of Texas, urgent cares such as CareNow don't have staffing, equipment or facility requirements, according to a report by the Legislative Budget Board.

They offer extended hours, usually 8 a.m. to 8 p.m. and at least one weekend day; typically accept a range of insurance; and can take care of minor injuries and illnesses.

Urgent cares may offer convenient features, such as online booking. At CareNow in Grapevine, patients get pagers that alert them when it is their turn to be seen, so they are not stuck in the waiting room.

But the urgent care centers vary on acceptance of Medicare and Medicaid.

CareNow does not accept either.

Dr. Frank Genco, who owns EMC Express Care at 8245 Precinct Line Road at the North Richland Hills/Colleyville border, said his clinic does accept Medicare but not Medicaid.