Urgent care mislead me into thinking they were in-network. Received out-of-network bill. What are my options?

Last month my usual in-network urgent care had a staffing issue and weren't seeing patients, so I found another one close by. I paid what I thought was a $20 copay and was seen. I don't remember if they confirmed whether or not they are in-network or if they "take" my insurance.

I received an out-of-network bill. My insurance company believes the copay is really a "facility charge". It is the exact amount as my in-network copay on my insurance card but it does not appear in my EOBs. My EOB lists the total cost after my insurance covered most of the bill ($0 copay and $150 charge) while my bill lists a different cost ($20 charge and $130 remaining).

I believe I have to pay the bill and it is technically my fault for not confirming with my health insurance company which other urgent cares near me are in-network. However when I called the urgent care today I was told they are busy and I can try calling back tomorrow about the bill.

This doesn't seem right to me, is this some sort of fraud? What is stopping them from charging a "facility fee" conveniently the same amount as anyone's in-network copay to mislead them that they are in-network?

submitted by /u/vorkbot
[comments]