Providence’s emergency room at St. Joseph Hospital. Photo by Ryan Burns.
A sudden policy shift by the health care provider Providence last week caused some turmoil at a local urgent care facility. However, a Providence executive clarified that the change is primarily administrative.
Redwood Urgent Care was notified on July 15 that patients covered by Providence’s health insurance plan, particularly those with HMO plans involving Providence Medical Group, now need prior approval from their HMO or insurance provider before receiving treatment at Redwood.
Since Redwood Urgent Care isn’t affiliated with Providence, patients must seek care elsewhere to avoid this new requirement. Other urgent care centers that are contracted with Providence do not require such authorization. But it’s worth noting that Redwood is the only one of its kind in Humboldt County, while OpenDoor operates a “same-day appointment clinic,” which is not exactly the same service.
This change impacts about 1,800 individuals in Humboldt County serviced through the HMO Western Health Advantage, according to Providence’s Regional Chief Executive Bob Just.
Just explained that Providence aims to manage costs associated with employee insurance by keeping as many urgent care visits within their network as feasible. He expressed confidence that this policy change wouldn’t significantly affect patients, claiming that daily access to primary care and telehealth services mitigates potential issues.
He noted, “If a patient needs urgent care when primary care or telehealth are unavailable, then services would be approved if an authorization is provided.”
In the absence of approval, patients might have to pay out-of-pocket or use the emergency room at St. Joseph Hospital, which typically incurs higher costs than urgent care visits.
