Whether or not you have health insurance and need medical treatment, it’s important to know the difference between an Urgent Care clinic and an emergency room so that you can get the right type of treatment at the appropriate place. The two options are different in terms of what they offer, how much they cost, whether they take insurance, and who provides them. Understanding when each type of care is appropriate will help you decide whether to see an Urgent Care doctor or head straight to the hospital.
Urgent Care vs. ER
Emergency rooms provide immediate care for serious and life-threatening conditions. Urgent care centers are for non-emergencies, but they can treat many types of injuries and illnesses, including some that you’d find at an emergency room. Urgent care centers are not intended to be a replacement for your Primary Care Provider or other medical services.
Urgent Care facilities do not offer the same level of care as hospital emergency rooms. The goal of Urgent Care clinics is to provide patients with quicker access to treatment than they would get waiting for an appointment with their primary doctor or visiting an emergency room (ER). If you have a condition that requires immediate attention but isn’t life threatening, such as a broken bone or severe sore throat, you may want to visit an Urgent Care center instead of waiting hours in line at an ER or taking time off work to see your primary physician.
When do I need Urgent Care?
Urgent care is a great option for many conditions. If you have an injury or illness that is not life-threatening, but needs to be seen quickly, Urgent Care can provide you with the treatment you need quickly, usually within an hour or two. Urgent Care clinics typically accept walk-in patients, or you can schedule your appointment ahead of time for even faster service. Urgent Care centers also offer testing and treatment for conditions such as allergies, allergic reactions, ear infections, sore or strep throats, and flu symptoms.
If you have an ongoing medical problem or have recently been diagnosed with a condition such as diabetes or hypertension, it’s important that your Primary Care Physician (PCP) knows about these issues so they can provide appropriate ongoing care. Your PCP should always be the first line of defense against serious illnesses like heart attack or stroke by monitoring risk factors such as high blood pressure. That said, there may come times when more immediate attention is required than a PCP can provide. In these instances, Urgent Care can fill the gaps when you need to be seen promptly, but aren’t facing a true medical emergency
Insurance and Urgent Care: the current landscape
Unfortunately, many insurance companies will not cover Urgent Care visits, which means you might be required to pay for the entire visit yourself. If you have no insurance, this may pose a problem because the out-of-pocket fees at urgent acres can be expensive. Swift Urgent Care centers offer an out-of-pocket rate that is half that of the leading Urgent Care chain. We aim to keep prices accessible for our communities because we understand that cost can be a significant barrier to accessing care for many.
If your insurer does cover Urgent Care visits and they happen to be in-network with your provider (meaning that they have contracts with the same insurance companies), then there are ways around paying out-of-pocket costs at an Urgent Care center.To find out if your insurer covers Urgent Care, look at the policy or ask your agent or employer before visiting an Urgent Care clinic.
If you have an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization) or EPO (Exclusive Provider Organization) plan, it’s likely that you are covered under these types of plans because all three types provide health care services outside of an emergency room setting. However, there may be limitations on what kind of treatment is covered by each type and how much they’ll pay toward specific procedures like X-rays or lab tests done at the same time as visits made at an Urgent Care clinic instead of one operated by their network providers themselves
You can also call your insurer directly — many companies will answer questions about specific plans over the phone without requiring customers’ full medical history before providing answers.
Urgent care is available to everyone regardless of insurance status.
You will not be turned away from Urgent Care based on your insurance status. You can pay for Urgent Care using cash, a credit card or one of the following:
- Health savings account (HSA): This is an account that you can use to pay for out-of-pocket medical expenses. The money in your HSA belongs to you and will roll over from year to year, but it’s meant for saving up so that you’re ready when unexpected health events arise. Contributions are tax deductible and withdrawals aren’t taxed as long as they go toward qualified medical expenses or used within 60 days of withdrawing them from the account.
- Flexible Spending Account (FSA): An FSA allows employees to set aside pre-tax dollars each month toward paying for their eligible healthcare costs such as copays and deductibles incurred during the plan year period. FSAs are tied directly into the employee’s paycheck so that funds are automatically deducted each pay period until all eligible amounts have been spent or exhausted by December 31st each year when enrollment ends.
What if I have no insurance and need Urgent Care?
If you don’t have insurance and need Urgent Care, there are a few options.
- You can pay out of pocket. This is the most expensive option, but if you’re uninsured and can’t afford to pay for medical care yourself, it might be your only option.
- You may qualify for free or discounted Urgent Care. The Affordable Care Act requires all health plans sold in the Marketplace to cover certain preventive services without cost-sharing (copays). If your symptoms are considered a “chronic condition” by your doctor (such as diabetes or high blood pressure) and they’ve been diagnosed before your Urgent Care visit, then the office visit should be covered under these provisions of ACA law.
Know the difference between Urgent Care and the ER, and understand what your insurance covers.
It’s important to know the difference between Urgent Care and emergency services so you know which option to choose in the event that you need medical attention. In general, emergency services are for life-threatening situations and Urgent Care is for non-life threatening situations.
Emergency services are covered by many insurances, but not always at 100% cost sharing. Urgent Care may or may not be covered by your plan depending on what kind of plan you have and where you go for treatment. If you have an HMO (Health Maintenance Organization) plan and receive treatment at an Urgent Care center instead of going directly to a hospital emergency room, then there’s a chance that your visit will not be fully covered by insurance.
The best way to anticipate the out-of-pocket costs of a visit to an ER or Urgent Care is to understand the scope of your insurance, what kinds of care it covers, and at what rate. Insurance plans can vary wildly, so if you have any questions about your coverage, contact your insurer to inquire.
Summing it up:
Urgent Care and insurance are both important parts of the healthcare landscape. Urgent Care can help people get the care they need promptly, without having to wait for hours in a crowded ER or for days or weeks for an appointment with their PCP. Insurance allows patients to get the services they need without having to pay out of pocket for them. Both are essential parts of maintaining good health and ensuring that people have access to quality medical care when they need it most.
Whether you’re looking to inquire about insurance, urgent care, or both, Swift is here to help. Contact us directly from our website, call our main office, or visit either of our convenient locations to meet with our team. We understand that navigating the healthcare system can be challenging and we’re here to help make it as simple as possible.