Its Called an Urgent Care Emergency Center But Which Is It?

Published

1 year ago

June 24, 2024

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One evening last December, Tieqiao Zhang felt severe stomach pain.

This story also ran on NPR. It can be republished for free.

After it subsided later that night, he thought it might be food poisoning. When the pain returned the next morning, Zhang realized the source of his pain might not be as simple as bad food.

He didnt want to wait for an appointment with his regular doctor, but he also wasnt sure if the pain warranted emergency care, he said.

Zhang, 50, opted to visit Parkland Healths Urgent Care Emergency Center, a clinic near his home in Dallas where hed been treated in the past. Its on the campus of Parkland, the citys largest public hospital, which has a separate emergency room.

He believed the clinic was an urgent care center, he said.

A CT scan revealed that Zhang had a kidney stone. A physician told him it would pass naturally within a few days, and Zhang was sent home with a prescription for painkillers, he said.

Five days later, Zhangs stomach pain worsened. Worried and unable to get an immediate appointment with a urologist, Zhang once again visited the Urgent Care Emergency Center and again was advised to wait and see, he said.

Two weeks later, Zhang passed the kidney stone.

Then the bills came.

The Patient: Tieqiao Zhang, 50, who is insured by BlueCross and BlueShield of Texas through his employer.

Medical Services: Two diagnostic visits, including lab tests and CT scans.

Service Provider: Parkland Health & Hospital System. The hospital is part of the Dallas County Hospital District.

Total Bills: The in-network hospital charged $19,543 for the two visits. BlueCross and BlueShield of Texas paid $13,070.96. Zhang owed $1,000 to Parkland a $500 emergency room copay for each of his two visits.

What Gives: Parklands Urgent Care Emergency Center is whats called a freestanding emergency department.

The number of freestanding emergency rooms in the United States grew tenfold from 2001 to 2016, drawing attention for sending patients eye-popping bills. Most states allow them to operate, either by regulation or lack thereof. Some states, including Texas, have taken steps to regulate the centers, such as requiring posted notices identifying the facility as a freestanding emergency department.

Urgent care centers are a more familiar option for many patients. Research shows that, on average, urgent care visits can be about 10 times cheaper than a low-acuity or less severe visit to an ER.

But the difference between an urgent care clinic and a freestanding emergency room can be tough to discern. Email Sign-Up

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Generally, to bill as an emergency department, facilities must meet specific requirements, such as maintaining certain staff, not refusing patients, and remaining open around the clock.

The freestanding emergency department at Parkland is 40 yards away from its main emergency room and operates under the same license, according to Michael Malaise, the spokesperson for Parkland Health. It is closed on nights and Sundays.

(Parklands president and chief executive officer, Frederick Cerise, is a member of KFFs board of trustees. KFF Health News is an editorially independent program of KFF.) The hospital is very transparent about the centers status as an emergency room, Malaise told KFF Health News in a statement.

Malaise provided photographs of posted notices stating, This facility is a freestanding emergency medical care facility, and warning that patients would be charged emergency room fees and could also be charged a facility fee. He said the notices were posted in the exam rooms, lobby, and halls at the time of Zhangs visits.

Zhangs health plan required a $500 emergency room copay for each of the two visits for his kidney stone.

When Zhang visited the center in 2021 for a different health issue, he was charged only $30, his plans copay for urgent care, he said. (A review of his insurance documents showed Parkland also used emergency department billing codes then. BCBS of Texas did not respond to questions about that visit.)

One reason I went to the urgent care instead of emergency room, although they are just next door, is the copayment, he said.

The list of services that Parklands freestanding emergency room offers resembles that of urgent care centers including, for some centers, diagnosing a kidney stone, said Ateev Mehrotra, a health care policy professor at Harvard Medical School.

Having choices leaves patients on their own to decipher not only the severity of their ailment, but also what type of facility they are visiting all while dealing with a health concern. Self-triage is a very difficult thing, Mehrotra said.

Zhang said he did not recall seeing posted notices identifying the center as a freestanding emergency department during his visits, nor did the front desk staff mention a $500 copay. Plus, he knew Parkland also had an emergency room, and that was not the building he visited, he said.

The name is misleading, Zhang said. Its like being tricked. In severe pain and uncertain of its cause, Tieqiao Zhang of Dallas says he didnt want to wait for an appointment with his regular doctor, but he also wasnt sure if he needed emergency care. He visited a clinic on the campus of Dallas largest public hospital and was charged 10 times what he expected.(Laura Buckman for KFF Health News)

Parkland opened the center in 2015 to reduce the number of patients in its main emergency room, which is the busiest in the country, Malaise said. He added that the Urgent Care Emergency Center, which is staffed with emergency room providers, is an extension of our main emergency room and is clearly marked in multiple places as such.

Malaise first told KFF Health News that the facility isnt a freestanding ER, noting that it is located in a hospital building on the campus. Days later, he said the center is held out to the public as a freestanding emergency medical care facility within the definition provided by Texas law.

The Urgent Care Emergency Center name is intended to prevent first responders and others facing life-threatening emergencies from visiting the center rather than the main emergency room, Malaise said.

If you have ideas for a better name, certainly you can send that along for us to consider, he said.

Putting the term urgent in the clinics name while charging emergency room prices is disingenuous, said Benjamin Ukert, an assistant professor of health economics and policy at Texas A&M University.

When Ukert reviewed Zhangs bills at the request of KFF Health News, he said his first reaction was, Wow, I am glad that he only got charged $500; it could have been way worse for instance, if the facility had been out-of-network.

The Resolution: Zhang said he paid $400 of the $1,000 he owes in total to avoid collections while he continues to dispute the amount.

Zhang said he first reached out to his insurer, thinking his bills were wrong, before he reached out to Parkland several times by phone and email. He said customer service representatives told him that, for billing purposes, Parkland doesnt differentiate its Urgent Care Emergency Clinic from its emergency department. More from Bill of the Month He Fell Ill on a Cruise. Before He Boarded the Rescue Boat, They Handed Him the Bill. May 22, 2024 Sign Here? Financial Agreements May Leave Doctors in the Drivers Seat Apr 30, 2024 A Moms $97,000 Question: How Was Her Babys Air-Ambulance Ride Not Medically Necessary? Mar 25, 2024 More from the series

BlueCross and BlueShield of Texas did not respond to KFF Health News when asked for comment.

Zhag said he also reached out to a county commissioners office in Dallas, which never responded, and to the Texas Department of Health, which said it doesnt have jurisdiction over billing matters. He said the staff for his state representative, Morgan Meyer, contacted the hospital on his behalf, but later told him the hospital would not change his bill.

As of mid-May, his balance stood at $600, or $300 for each visit.

The Takeaway: Lawmakers in Texas and around the country have tried to increase price transparency at freestanding emergency rooms, including by requiring them to hand out disclosures about billing practices.

But experts said the burden still falls disproportionately on patients to navigate the growing menu of options for care.

Its up to the patient to walk into the right building, said Mehrotra, the Harvard professor. It doesnt help that most providers are opaque about their billing practices, he said.

Mehrotra said that some freestanding emergency departments in Texas use confusing names like complete care, which mask the facilities capabilities and billing structure.

Ukert said states could do more to untangle the confusion patients face at such centers, like banning the use of the term urgent care to describe facilities that bill like emergency departments.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Emily Siner reported the audio story.

Renuka Rayasam: rrayasam@kff.org, @renurayasam Related Topics Health Care Costs States Bill Of The Month Hospitals Investigation Texas Contact Us Submit a Story Tip

Politics

‘Shameful’ that black boys in London more likely to die than white boys, says Met Police chief

Published

3 hours ago

July 13, 2025

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'Shameful' that black boys in London more likely to die than white boys, says Met Police chief

It is “shameful” that black boys growing up in London are “far more likely” to die than white boys, Metropolitan Police chief Sir Mark Rowley has told Sky News.

In a wide-ranging interview with Sunday Morning with Trevor Phillips, the commissioner said that relations with minority communities are “difficult for us”, while also speaking about the state of the justice system and the size of the police force.

Sir Mark, who came out of retirement to become head of the UK’s largest police force in 2022, said: “We can’t pretend otherwise that we’ve got a history between policing and black communities where policing has got a lot wrong.

“And we get a lot more right today, but we do still make mistakes. That’s not in doubt. I’m being as relentless in that as it can be.”

He said the “vast majority” of the force are “good people”.

However, he added: “But that legacy, combined with the tragedy that some of this crime falls most heavily in black communities, that creates a real problem because the legacy creates concern.”

Sir Mark, who also leads the UK’s counter-terrorism policing, said black boys growing up in London “are far more likely to be dead by the time they’re 18” than white boys.

“That’s, I think, shameful for the city,” he admitted.

“The challenge for us is, as we reach in to tackle those issues, that confrontation that comes from that reaching in, whether it’s stop and search on the streets or the sort of operations you seek.

“The danger is that’s landing in an environment with less trust.

“And that makes it even harder. But the people who win out of that [are] all of the criminals.”

The commissioner added: “I’m so determined to find a way to get past this because if policing in black communities can find a way to confront these issues, together we can give black boys growing up in London equal life chances to white boys, which is not what we’re seeing at the moment.

“And it’s not simply about policing, is it?”

Sir Mark said: “I think black boys are several times more likely to be excluded from school, for example, than white boys.

“And there are multiple issues layered on top of each other that feed into disproportionality.”

‘We’re stretched, but there’s hope and determination’

Sir Mark said the Met is a “stretched service” but people who call 999 can expect an officer to attend.

“If you are in the middle of the crisis and something awful is happening and you dial 999, officers will get there really quickly,” Sir Mark said.

“I don’t pretend we’re not a stretched service.

“We are smaller than I think we ought to be, but I don’t want to give a sort of message of a lack of hope or a lack of determination.”

“I’ve seen the mayor and the home secretary fighting hard for police resourcing,” he added.

“It’s not what I’d want it to be, but it’s better than it might be without their efforts.”

‘Close to broken’ justice system ‘frustrating’ and ‘stressed’

Sir Mark said the criminal justice system was “close to broken” and can be “frustrating” for others.

“The thing that is frustrating is that the system – and no system can be perfect – but when the system hasn’t managed to turn that person’s life around and get them on the straight and narrow, and it just becomes a revolving door,” he said.

“When that happens, of course that’s frustrating for officers.

“So the more successful prisons and probation can be in terms of getting people onto a law-abiding life from the path they’re on, the better.

“But that is a real challenge. I mean, we’re talking just after Sir Brian Leveson put his report out about the close-to-broken criminal justice system.

“And it’s absolutely vital that those repairs and reforms that he’s talking about happen really quickly, because the system is now so stressed.”

Challenge to reform the Met

The Met chief’s comments come two years after an official report found the force is institutionally racist, misogynistic and homophobic.

Baroness Casey was commissioned in 2021 to look into the Met Police after serving police officer Wayne Couzens abducted, raped and murdered Sarah Everard.

She pinned the primary blame for the Met’s culture on its past leadership and found stop and search and the use of force against black people was excessive.

At the time, Sir Mark, who had been commissioner for six months when the report was published, said he would not use the labels of institutionally racist, institutionally misogynistic and institutionally homophobic, which Baroness Casey insisted the Met deserved.

However, London Mayor Sadiq Khan, who helped hire Sir Mark – and could fire him – made it clear the commissioner agreed with Baroness Casey’s verdict.

A few months after the report, Sir Mark launched a two-year £366m plan to overhaul the Met, including increased emphasis on neighbourhood policing to rebuild public trust and plans to recruit 500 more community support officers and an extra 565 people to work with teams investigating domestic violence, sexual offences and child sexual abuse and exploitation.

Watch the full interview on Sunday Morning with Trevor Phillips from 8.30am on Sunday.

Politics

Unite votes to suspend Angela Rayner over Birmingham bin strike

Published

3 hours ago

July 13, 2025

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Unite votes to suspend Angela Rayner over Birmingham bin strike

Labour’s largest union donor, Unite, has voted to suspend Deputy Prime Minister Angela Rayner over her role in the Birmingham bin strike row.

Members of the trade union, one of the UK’s largest, also “overwhelmingly” voted to “re-examine its relationship” with Labour over the issue.

They said Ms Rayner, who is also housing, communities and local government secretary, Birmingham Council’s leader, John Cotton, and other Labour councillors had been suspended for “bringing the union into disrepute”.

There was confusion over Ms Rayner’s membership of Unite, with her office having said she was no longer a member and resigned months ago and therefore could not be suspended.

But Unite said she was registered as a member. Parliament’s latest register of interests had her down as a member in May.

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The union said an emergency motion was put to members at its policy conference in Brighton on Friday.

Unite is one of the Labour Party’s largest union donors, donating £414,610 in the first quarter of 2025 – the highest amount in that period by a union, company or individual.

The union condemned Birmingham’s Labour council and the government for “attacking the bin workers”.

Mountains of rubbish have been piling up in the city since January after workers first went on strike over changes to their pay, with all-out strike action starting in March. An agreement has still not been made.

Ms Rayner and the councillors had their membership suspended for “effectively firing and rehiring the workers, who are striking over pay cuts of up to £8,000”, the union added.

‘Missing in action’

General secretary Sharon Graham told Sky News on Saturday morning: “Angela Rayner, who has the power to solve this dispute, has been missing in action, has not been involved, is refusing to come to the table.”

She had earlier said: “Unite is crystal clear, it will call out bad employers regardless of the colour of their rosette.

“Angela Rayner has had every opportunity to intervene and resolve this dispute but has instead backed a rogue council that has peddled lies and smeared its workers fighting huge pay cuts.

“The disgraceful actions of the government and a so-called Labour council, is essentially fire and rehire and makes a joke of the Employment Relations Act promises.

“People up and down the country are asking whose side is the Labour government on and coming up with the answer not workers.”

Sir Keir Starmer’s spokesman said the government’s “priority is and always has been the residents of Birmingham”.

He said the decision by Unite workers to go on strike had “caused disruption” to the city.

“We’ve worked to clean up streets and remain in close contact with the council […] as we support its recovery,” he added.

A total of 800 Unite delegates voted on the motion.

Politics

Dozens of MPs call for UK government to recognise Palestine as state

Published

3 hours ago

July 13, 2025

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Dozens of MPs call for UK government to recognise Palestine as state

Nearly 60 Labour MPs have called on David Lammy and the Foreign Office to immediately recognise Palestine as a state.

A mix of centrist and left-wing MPs, including some committee chairs, wrote to the foreign secretary this week to say “by not recognising [Palestine] as a state, we undermine our own policy of a two-state solution and set an expectation that the status quo can continue and see the effective erasure and annexation of Palestinian territory”.

The 59 MPs suggest the government pursue five different measures to prevent the Israeli government from carrying out its Rafah plan, adding that they believed Gaza was being “ethnically cleansed” – a claim vehemently denied by Israel.

The letter was organised by Labour Friends of Palestine and the Middle East group.

It states that the Israeli plan, which would see the “population transfer to the southern tip of Gaza in preparation for deportation outside the strip”, is an accurate description, but that they believe a clearer way to describe it is the “ethnic cleansing of Gaza”.

Israeli officials have said they want to separate the civilian population from Hamas, which still controls parts of Gaza and holds dozens of hostages abducted in the October 7 attack that triggered the war 21 months ago.

Emmanuel Macron discussed recognising Palestine as a state at a joint news conference with Sir Keir Starmer on Thursday – the same day the letter was signed.

The French president said: “Today, working together in order to recognise the state of Palestine and to initiate this political momentum is the only path to peace.”

While France has not yet recognised a Palestinian state yet, Norway, Ireland and Spain coordinated their recognition last year.

The letter demands ministers take five different measures to:

• Recognise the state of Palestine
• Continue support for the UN Agency for Palestinian Refugees (UNRWA)
• Secure the release of hostages
• Press for the full and unhindered resumption of humanitarian aid
• Fully review and place restrictions on trade with and financial support of illegal Israeli settlements in the West Bank

The government says it is already providing funding for the UNRWA and working to secure the release of hostages held by Hamas, but immediate recognition of Palestinian statehood will be a much more controversial move.

Sky News understands this is the second time MPs have formally called on the government to immediately recognise the state of Palestine, with previous letters signed by some parliamentary aides and even junior ministers.

Ministers have indicated their plan to recognise Palestine would be “at a time that is most conducive to the peace process” without further clarity of when that might be.

They have also indicated that it would not be suitable to speculate about future sanctions, as this could reduce their impact.

A Foreign Office spokesperson said: “Since day one, this government has been clear that we need to see an immediate ceasefire, the release of all hostages cruelly detained by Hamas, better protection of civilians, much-needed food aid, medicines, shelter and other supplies immediately being allowed to enter Gaza, and a path to long-term peace and stability.

“The situation on the ground in Gaza is horrendous – for the hostages and for Palestinians – and we urgently want to see a deal done, to end the suffering on all sides.

“We are committed to recognising a Palestinian state and to doing so when will have most impact in support of a peace process. We continue to provide lifesaving aid to supporting Palestinians in Gaza and the West Bank, and to work closely in support of the Palestinian Authority.”