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Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

J.L. Sousa

Dear Tom and Alan:

Thanks for the information you deliver in your column. Very informational and entertaining. I must be easily amused. Anyway, I purchased a SCAN Medicare Advantage Plan from you last year during open enrollment.

So far it’s working great. The brochure they sent me says there is an urgent care benefit available for a copay. Is that the emergency room at the Queen? I’m not aware of a facility for “urgent care.”

Uninformed

Tom: Yes, we have an urgent care center in American Canyon. It is called New MD Urgent Care and is located at 3431 Broadway St. The center treats non-life-threatening illnesses and accidents. Although I’m sure that if you were to walk in with a severed body part they would help you too.

In addition, the Queen will also be opening an urgent care center in the Riverpark shopping center.

Al: I checked the 2017 SCAN brochure. Your visit to most urgent care centers is subject to a $25 copay for worldwide services. In contrast, your plan requires a $75 copay in the emergency room. The $75 is waived if you are immediately admitted into the hospital.

Our reader didn’t ask, but in the case of being admitted into the hospital, the copay is $195 per day for the first five days, then no copay for up to 90 days.

Since SCAN does not have a deductible, all the additional charges in the hospital would accumulate toward the annual maximum out of pocket amount of $3,400. After that, everything’s covered at 100 percent.

Tom: Sounds pretty good, since the average cost for a hospital stay is $12,000.

There are an estimated more than 160 million urgent care visits annually, 75 percent of the centers are in suburban neighborhoods and 25 percent of emergency room visits could be handled in urgent care.

Al: One of the recurring problems of the past has been when people go to an emergency room, are not admitted and then face a huge bill because it “doesn’t qualify” as an emergency without a hospital admission.

The problem was compounded when the individuals discovered that the emergency room providers were not contracted with any insurance carrier. If an ambulance was involved, many of the emergency response teams are not contracted either.

Submit questions or reach the Health Insurance Guys at Schrette Insurance, 1556 First St., Suite 105, Napa, 94559; 255-9511; schrette@gmail.com; or alancash@gmail.com.

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