ER - life or death (if you can drive yourself, it's probably not an emergency)
Urgent Care - you have the flu, and your PCP isn't available; minor emergencies (but you can still drive yourself)
PCP - flu, check-ups, whatever
The balance billing and OON charges are separate issues from over-use of the ER.
How did the determination that you needed urology, "oops, no urology available", and ambulance transport get arranged? It seems like some level of triage, routing, unable, re-routing had to have happened, right?
But yes, hospital two tried to charge me for an ER visit, as well as the surgical billing (which of course was reasonable).
Shock, horror, you actually need to read through the form and select the appropriate checkboxes (around ability to stand, need for oxygen, fall risk and hazard, danger to self or others, etc., etc.)
Too many of them literally fill out patient demographics and a signature and say "here you go".
We push back because our organization policy is that we will transport those patients, BUT we would also much rather bill Medicare than the patient (our billing staff and C-suite may disagree, but EMTs and paramedics wholeheartedly understand that routine privately paid ambulance transport is not a viable option for 99.998% of the elderly).
At no point did the ER staff ever talk to me. At no point was I in a room. Or in an ER bed, hallway or otherwise. Just ambulance, transport, and then to pre-op.
But, because the transfer physically happened in the ER, that second hospital tried to bill my insurance for an ER visit to the tune of $2,800 which I appealed (successfully, at least).