Tips for Utilizing Urgent Care vs. ER

Top Tip: make a list of nearby Urgent Care and ERs that are in-network, and put it on your fridge for quick reference when needed

This week the focus is on is the different kinds of coverages that your policy may have, and when to use those coverages. It can be difficult at times to navigate which type of care you think you or your family member will need in a given situation – primary care physician, telemedicine, ER, or Urgent Care. The costs for these services differ greatly and are billed differently to your insurance plan. Depending on co-pays and your deductible, utilizing these services can be very expensive.

Let’s discuss your options in terms of “lines of defense” and priority vs cost:

  1. Telemedicine:
    • Many policies have TeleDoc options for tele visit options. That is your first line of defense and is going to be your least costly option if you need medical care. I always encourage people to make sure that if you have TeleDoc or telehealth, you have it all set up. This is so that when you do need it, you can call and use it.
  1. PCP:
    • Your second line of defense is your primary care doctor. This is in-person, and you may have a copay for that visit if you’re sick, but this is still a relatively inexpensive option compared to the next two.
  1. Urgent Care:
    • The next line of defense would be Urgent Care – and the focus of today’s blog.

Urgent Care can do many, many of the things that ERs can do. If you’re having a heart attack, you do need to go to the ER, but there are many things Urgent Cares can deal with. They can take care of broken bones, stitches, respiratory issues, and more. You would go to Urgent Care primarily if it’s after hours or on the weekend, and your primary care is not available, and you don’t have telehealth, or it’s an issue such as stitches that needs to be dealt with.

I always encourage my clients is to find out ahead of time which Urgent Care is in-network and to make a list based on which is closest to them. This can apply to both Urgent Cares and ERs because when you do have an emergency or an urgent situation, you don’t want to have to worry about finding an in-network doctor, you already want to know where you need to go.

Urgent Care is considerably less expensive than the ER. I always recommend you go there before trying the ER – unless an extreme emergency requires the ER. A lot of healthcare plans, don’t expect you to have to meet a deductible before they will pay for Urgent Care, and there’s usually just a copay for Urgent Care.

  1. ER:
    • Your last line of defense is the ER. I tell all my clients that you really should reserve the ER for dire situations. If you’re not feeling well, such as you have a stomach bug, do not go to the ER. You are going to get charged 1000s and 1000s of dollars at the ER, and you’re probably going to be on the hook for this because you may have a big deductible you’d have to meet. This is because, for a lot of healthcare plans, ER visits are not covered until you hit your deductible. So, if your deductible is $5000 or $8000, that means you’re going to get a bill from the ER. The ER has overinflated prices, to begin with, meaning that not only are you stuck with a large bill, but it is often quadruple charging you. Yes, often up to quadruple what the normal fee should be for a type of service that Urgent Care does at a fraction of the cost. Again, please don’t use the ER unless you have no other choice, because that can be very expensive.

Top tip:

What do you do if you do need to go to the ER? Well, sometimes it might be best just to tell them you’re a cash pay patient.

If you don’t present an insurance card and you tell them you are a cash patient, you may initially get a bill, but then you can call and ask for a cash discount. Because if you have a deductible, that’s $5000 or $8000, you’re going to owe that.

(There’s one hospital in particular that I know of that will give you an 89% discount if you are cash pay. So if they charge you $10,000 and they take off 89% as the discount,  you’re looking at a bill of around $1000-1100, which is way better than $5,000 or $8,000!)

The bottom line is: knowing where to go ahead of time.

A lot of people use the ER just for regular visits. Not only does that tie up the ER when there are more urgent things that come in but it is a lot more expensive for you!

Remember to schedule an appointment with me on my website for more information and tips on healthcare!

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