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Florida freestanding ER bills stun patients after routine visits

Freestanding emergency departments are expanding across Florida, bringing emergency care closer to home. But patients tell the Tampa Bay 28 I-Team routine visits resulted in big bills.

By: Adam Walser

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TAMPA, Fla. — Freestanding emergency departments have become increasingly difficult to miss across Tampa Bay.

These facilities promise convenient access to emergency care without requiring patients to travel to a traditional hospital campus.

But several patients told the Tampa Bay 28 I-Team that they did not fully understand the potential cost when they walked through the doors.

Freestanding emergency centers are showing up all over the Sunshine State

One patient said his insurer was billed more than $8,000 after a doctor treated his dislocated finger.

Another said a freestanding emergency room billed $35,000 following a visit for rabies vaccinations.

A third patient received more than $17,000 in charges after suffering a head injury.

Patients get big bills — These three patients got unexpected big bills from freestanding emergency centers in Tampa Bay

“I think there’s something really broken here,” Abram Jacobson said. “And I know I’m not the only one, and this was a really trivial instance.”

Freestanding emergency departments expand across Florida

Florida has 166 hospital-based, off-campus emergency departments, accounting for nearly 2 million visits, according to information reviewed by the I-Team.

166 off-campus emergency rooms — AHCA statistics show 166 freestanding emergency centers in Florida had nearly two million visits

Unlike an urgent care clinic, a freestanding emergency department operates as a hospital emergency room and charges emergency department rates.

A Florida House analysis from 2021 found that treatment at an urgent care center averaged approximately $193, compared with more than $2,000 at a freestanding emergency department.

A separate academic study found that each additional freestanding emergency center entering a market was associated with an average 3.6 percentage-point increase in emergency department spending.

Study shows new Emergency Centers drove up overall costs — A study shows that each new freestanding ER that opened in a market drove up overall emergency care spending by 3.6 %

“The number one cost driver of every health plan in the United States is the emergency room,” said Bill Hennessey, a physician and patient billing advocate.

For less serious conditions in which a patient does not expect to be admitted to a hospital, Hennessey said urgent care treatment typically costs approximately $200 to $300.

“There’s a money-making opportunity,” he said. “Just follow the money.”

An $8,000 bill to treat a dislocated finger

Mark Currier dislocated a finger while playing basketball at a recreation center.

“It was bent back about a 90-degree angle,” he said.

Concerned that the finger might be broken, Currier searched online for nearby medical care and went to the closest freestanding emergency department that appeared on his phone.

Mark Currier visited a freestanding ER for a dislocated finger and received an $8,000 bill

“They ended up taking my finger and pulling it straight, which hurt, and put it in a splint and said, ‘OK, thank you very much,’” he recalled.

Then the bill arrived.

“The overall fee that they billed my insurance company was over $8,000 to pull my finger,” Currier said.

Currier said he believed an urgent care center could have treated the injury.

“Absolutely,” he said. “It wasn’t complicated at all.”

He also acknowledged that he did not understand the difference between an urgent care clinic and a standalone emergency center when he sought treatment.

“I didn’t,” Currier said. “I just Googled it and went to the closest place that came up on my phone.”

A $35,000 charge following a bat encounter

Abram Jacobson’s experience began when his dogs cornered a bat in his yard.

Jacobson said he found the bat and touched its chest with one finger to check whether its heart was beating.

As a precaution, he took his dogs to a veterinarian for rabies booster shots, which he said cost $180 for both animals.

Abram Jacobson and his dog — Abram Jacobson was told by state authorities to seek treatment after he came into contact with a bat. He says a 30-minute visit to a freestanding emergency center resulted in a $35,000 bill

The veterinarian reported the incident to health officials, who directed Jacobson to seek medical treatment. He went to a freestanding emergency department.

“I got in and out really quickly, and for me, a routine vaccination,” he said.

But the bill was far from routine.

“When I saw that they had billed $35,000 for the event, I was, ‘What? What universe am I living in?’” Jacobson said.

$35,000 statement of charges — Abram Jacobson received this statement from his insurance company, showing he was charged $35,000 for a rabies prevention course of treatment

Jacobson said the freestanding emergency department did not administer all the shots he needed.

He had to visit the health department for subsequent boosters.

More than $17,000 in charges after a head injury

Linene Kates was attending a boat show in Tampa when she tripped over a concrete wheel stop in a parking garage.

“I went headfirst into a concrete piling,” she said.

Kates went to a freestanding emergency department expecting that she would receive treatment faster.

Instead, she said she spent approximately nine hours there.

Linene Kates says she spent nine hours in a freestanding ER last year after hitting her head on a concrete pillar.

“Nobody ever came to check on me, and my son kept going up there asking for more ice packs because they would melt,” she said.

Kates underwent an MRI, was placed in a head wrap and was cleared to return home.

The total charges were $17,437, according to a bill she reviewed with the I-Team.

Kates said she also received a separate bill from the physician who treated her.

Florida requires freestanding ERs to warn patients

Florida lawmakers have acknowledged that patients may confuse freestanding emergency departments with urgent care centers.

State law requires freestanding emergency departments to post signs informing patients:

The facility is a hospital emergency department.
It is not an urgent care center.
Emergency department rates are charged for its services.

The facilities must also post their average facility fees.

Those fees can exceed $5,000 in some cases.

Hospital association says the facilities improve access

The Florida Hospital Association declined the I-Team’s request for an interview but disputed criticism of freestanding emergency departments.

In a statement, the association wrote:

"The demand for healthcare continues to rise as our state's population grows and ages. Additionally, families and visitors rely on timely access to healthcareservices when minutes matter. Whether restoring blood flow during a stroke, preserving an injured finger or addressing a psychiatric crisis, prompt diagnosesand treatments improve health outcomes and save lives. StandaloneEmergency Departments can complement existing hospitals and healthcare providers by bringing emergency carecloser to home and reducing wait times for patients."

How to decide where to seek treatment

Hennessey said patients experiencing a possible stroke, heart attack, broken bone or another serious condition should seek emergency care rather than visiting an urgent care clinic.

Dr. Bill Hennessey is a physician and medical billing expert

He also advised patients who believe they need emergency care to consider going to an emergency room attached to a hospital.

“I want someone who really thinks he or she needs emergency care to go to an emergency room that’s attached to a hospital, so that in the event that you need further care by a physician specialist inside the hospital, you’re already there,” Hennessey said.

For patients whose conditions are less serious, understanding the difference between urgent care and emergency care before arriving could help prevent an unexpected bill.

Here's a guide Hennessey provided to the I-Team:

Urgent Care Symptoms/Condition