Bryan Keller hopped his bike to go pick up groceries on a Sunday morning in November. The fall from his bike that left him with a gash on his head that needed stitches was quite the surprise. However, the medical bill that came later was much more surprising.
Keller’s health insurance covered much of the cost of his visit to the CityMD clinic on Manhattan’s Lower East Side. But it didn’t cover the physician who arrived to stitch his forehead — an out-of-network plastic surgeon with a Park Avenue office.
Under a law Congress passed last year, many surprise medical bills will be banned starting in January. In addition, patients with private insurance will be protected against unexpected charges for emergency out-of-network care, for treatment by out-of-network providers at in-network facilities, and transportation in air ambulances. However, there is a gray area: visits to urgent care clinics.
Urgent care clinics weren’t explicitly addressed in the No Surprises Act. Keller’s experience underscores patients’ predicament — insurers often try to steer patients to urgent care and away from costly emergency rooms, but they could still get hit with large bills. The Biden administration has expressed an interest in prohibiting surprise bills in clinics, which may treat severe conditions but not life-threatening injuries and illnesses.