Urgent care now being billed as ER

We have an urgent care copay but it’s nonexistent in billing

We took our child (4yr) to a freestanding urgent care clinic. We have used this place for years with no problem. However, we are being told by BCBS that our recent visit is no subject to our copay amount ($30) and we have to pay the billed charges as part of our deductible ($150) instead. BCBS says that the claim is being billed like an ER visit because it’s billed under a facility revenue code (0526) and not a provider code. And because they are billing as an ER and this wasn’t a true emergency, we have to pay more. The only other code that was billed was an established patient code. She was not tested for anything.

According to the urgent care facility (Fast Pace) they are billing based on BCBS’s rules and unfortunately this happens alot. But this is the first time we had this problem. The previous 3 visits she’s had this year were covered and BCBS claims the difference is because of covid codes.

Previous to covid we only had copays when using this facility and so I know this isn’t covid related.

When I asked BCBS where I could go to Urgent care and be able to use our Urgent care copay, they replied to go to primary care.

What’s the point in urgent care if it’s no different than an ER visit? And what’s the point in an insurance plan with an Urgent care copay if you can’t even use it?

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