ERs vs. Urgent Care Centers: Knowing the Difference Can Save a Bundle

When you are injured or sick enough to require emergency care, you don’t want the cost of that care to prevent you from seeking professional medical help. But there’s no ignoring the hefty price tag that accompanies a visit to a hospital emergency room. If it’s a true emergency requiring a call to 911, the ambulance crew aren’t going to ask about cost or insurance – they’re going to take you to the nearest or the most appropriate ER depending on your condition, especially if you may be having a heart attack, stroke or other medical event that renders you unresponsive, in shock or suffering from severe blood loss. But if the injury or illness you have experienced is not life threatening, your choice of service provider has a significant impact on the cost.

“Emergency care” is a broad term, ranging from serious injuries or life-threatening events toeye injuries, sprains, broken bones, earaches, sore throats, burns, fevers, infections, animal bites and much more. Deciding where to go can be confusing, and price shouldn’t deter you from seeking help. However, there are a wide variety of more affordable choices now available that offer different levels of emergency or “urgent” care that is sufficient for incidences that do not require emergency rooms, and won’t break the bank.

Knowing the difference is especially important. If you’re an employer, helping your employees choose the proper level of care will save you and them money. Copays and out-of-pocket costs for emergency room visits continue to rise in an effort to control costs. Dissuading patients from going to ERs when a walk-in clinic will do just fine is prudent and sensible. In fact, the next step in this cost-awareness evolution now being implemented by some health insurance carriers will be to penalize members who seek care at an ER when it is not medically necessary.

Protecting against unnecessary emergency medical costs

Ask your insurer for documentation on what your plan will and won’t cover if you or your employees need emergency care. For example, get clarity on your ER copay and coinsurance and on what the plan will cover if you’re not admitted. Your insurer can also tell you which area hospitals take your insurance. You also can then ask the billing department at your hospital of choice whether the ER doctors participate in your insurance plan. And because most insurers cover medically necessary ambulance rides, know how your plan defines that—typically, it means the patient is unconscious, bleeding heavily, or in severe pain.

But the biggest single step employees – patients – can take to reduce medical costs is to choose the right kind of medical care center for themselves and their children. While the emergency room can help care for any medical situation, it costs an average of three times more than a visit to an urgent-care center. In a non-life threatening situation, you can usually be treated at an urgent-care center effectively and far more quickly.

Walk-in urgent-care centers are typically staffed by at least one emergency medical physician, as well as physician assistants and advanced practice resident nurses. They handle non-life threatening situations, and many facilities have x-rays and labs onsite.

While hospital ERs are open 24/7, many urgent-care centers are open late and on weekends and holidays. Emergency rooms are meant for true medical emergencies and can handle trauma, diagnostic x-rays, surgical procedures and other life-threatening situations. In addition to the added cost, which averages approximately $2,300 according to industry data, the average wait at an ER is 4.5 hours. In comparison, the average cost of visiting an urgent-care center is $176, and waiting times are typically significantly shorter.

Visit an emergency room if you experience:

  • Allergic reactions to food, animal or bug bites
  • Broken bones
  • Chest pain
  • Constant vomiting
  • Continuous bleeding
  • Severe shortness of breath
  • Deep wounds
  • Weakness or pain in a leg or arm
  • Head injuries
  • Unconsciousness

Visit an urgent-care center for these common conditions:

  • Flu and cold
  • Coughs and sore throat
  • High fevers
  • Ear aches and potential eye infections
  • Vomiting, diarrhea, stomach pain
  • Cuts and severe scrapes
  • Minor broken bones such as fingers or toes
  • Minor injuries and burns

Getting the right care when needed always should be your priority. But with the plethora of urgent- and walk-in-care medical centers now available, making a wise and informed choice can save employees thousands of dollars and help stem the continuing rise in healthcare costs that affect all of us.


 

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