Where Should I Go? ER vs. Urgent Care

In 2016, Americans visited the emergency room over 145 million times, which was a 6.4 % increase over the year before. These numbers keep rising, in part due to patients who cannot afford regular medical care. But patients who can afford treatment use the ER for non-emergent conditions, too.

When you are in need to fast medical attention, your impulse may be to visit the emergency room, especially on the nights or weekends. You know that you'll find qualified doctors and nurses availabled whenever you need them, and you may have visited the ER many times over the course of your life.

However, if you have a choice, going to the emergency room should be reserved for truly life-threatening conditions. If you need immediate medical attention for a non-emergent situation, try going to an urgent care centers instead. The staff at an urgent care center can handle most illnesses and injuries quickly and at a lower cost than the emergency room charges. Plus, your wait is likely to be shorter. If you need the emergency room, by all means, go. But don't forget to consider your urgent care choices first. Forgoing the emergency room when possible can make your life easier and keep you from incurring medical debt.

Urgent Care

Urgent care clinics can handle most non-emergent situations. They usually have extended hours during the week and are also open on the weekends. If you are unable to visit your regular doctor, an urgent care can give you the care you need. Remember, a condition can be urgent but not an emergency. Consider visiting your urgent care clinic in the following instances:

• Simple fractures

• Stomach issues such as vomiting, diarrhea, nausea and extreme constipation

• Fevers - although babies and small children may need the ER

• Cuts and abrasions - The staff can easily take care of minor injuries, even those that need a few stitches.

• Minor infections such as ear and sinus infections

• Coughing

• Sore throat

• Blood Work

• Minor back pain

• Sprains and strains

• X-rays

• Allergies

• Rashes

• Urinary tract infections

• Cold and flu symptoms - if you suspect that you have a highly contagious condition, such as COVID-19, call ahead for instructions on where to go.

Urgent care centers are busy places, but your wait should be much shorter than in the ER. You can expect to wait anywhere from 15 to 40 minutes in an urgent care facility before seeing a doctor. In contrast, true medical crises take longer to treat, so you can easily spend hours waiting for a doctor in the emergency room. If your condition isn't life-threatening, you'll be bumped down the line when a real emergency arrives. Not surprisingly, the average waiting time is two hours and fifteen minutes.

Emergency Room

The ER is designed to treat real medical emergencies, but over the past decades has become a place for general treatment, often due to lack patients' lack of insurance. But you should choose to visit an ER if you are suffering symptoms or injuries that are life-threatening or that could permanently damage your health. Experts recommend choosing the emergency room if you are experiencing the following:

• Difficulty breathing

• Excessive bleeding

• Severe chest pain

• Severe abdominal pain

• Internal bleeding

• Intestinal bleeding

• Unconsciousness

• Disorientation

• Garbled speech

• Vaginal bleeding while pregnant

• High fevers - especially in children

• Repeated vomiting

• Extreme headaches

• Compound fractures

• Head injury

An ER is prepared to offer you a superior level of care for serious traumas and illnesses. The doctors and nurses are a highly trained professionals who are meant to deal with serious, often life-threatening issues. As a result, visiting the emergency room costs more, even for those with excellent insurance. Of course, urgent care teams are also highly trained, but they expect to treat the more common ailments of adults and children. So, you pay less while getting the treatment that you need. Going to the ER for a sprained ankle is an overreaction that taxes the healthcare system as well as your budget.

Urgent Care and Emergency Care Costs

The cost of care in an emergency room is much higher than care in an urgent care center. Claims paid by insurance companies show how costs vary on some of the most common health complaints ER and urgent-care doctors treat. For instance, strep throat treatment costs around $531 in an ER but only $111 in urgent care. Other differences include:

• Earaches: ER - $400. Urgent Care - $110

• Sore Throat: ER - $525. Urgent Care - $94

• Acute Bronchitis: ER - $595. Urgent Care - $127

• Urinary Tract Infection: ER room - $665. Urgent Care - $112

One reason for such high emergency room costs is the little-known facility fee that hospitals charge. This fee is used to cover the price of simply keeping the ER open, and it can vary from hundreds to thousands of dollars, depending on the facility. This expense comes as a surprise to many patients who have never heard of such a fee until they see it on their bill.

The cost of supplies used in the ER is also high. For instance, you may be charged $7 for a bandage and $10 for an ibuprofen. Usually, the patient isn't aware they could save money by stopping by a drugstore on the way home. You can expect to pay premium prices for everything you receive in an emergency room.

Urgent care centers also have overhead and may charge high prices for supplies, but their prices are generally much lower than the emergency room charges. An urgent care center simply costs car less to run than an ER, so patients can better afford its services.

Insurance Costs

Patients with insurance will pay less than those without coverage, of course, but even with a good policy, an emergency room visit can cost you plenty. Urgent care patients often have a copay that ranges between $25 and $75. Patients who haven't met their deductible may have to pay the entire cost out-of-pocket, but that cost is usually somewhere between $100 - $200. That amount may still sting, but it's usually manageable.

In contrast, ER visits can cost insured patients a pretty penny, depending on their insurance policy. Some policies have emergency room copays in the $250 - $500 range. Other policies have patients pay a percentage of the bill. That means you will first have to meet your deductible before the benefit kicks in. Then your coinsurance percentage will apply. That percentage also varies according to policy and can be anywhere from 50% to 10%.

Insurance companies may deliberately make these copays and coinsurance high to encourage you to avoid emergency rooms. They want to avoid paying out on expensive and unnecessary visits. ER visits are a big reason why healthcare costs in general keep rising at an alarming rate. Some uninsured people avoid seeking medical care until their condition becomes emergent. Then they have no choice but to seek help from an emergency room.

Insurance companies do want you to head to the ER when you have a serious or life-threatening issue, and you do not need a pre-authorization for such a visit. You may need to get one later if your physician wants to admit you. Your insurance company wants you to get the treatment you need, but they do not want you to make unnecessary visits.

An important note: your doctor may keep you under observation in the ER for 24 hours or more before releasing you or admitting you. Until you are admitted, you have outpatient status. Unfortunately, you may end up paying much more money for services as an outpatient than as an inpatient if you have private insurance. If you find yourself in this situation, you should consult with your insurance company for benefit information.

Finding the Right Policy

Before choosing a health insurance policy, consider what sort of emergency room coverage will best suit you and your family. If you or a loved one has a chronic condition that often sends you to the ER, you'll want to find coverage that comes with a reasonable copay. You may also want to consider your family history of strokes, heart attacks and other serious health issues when choosing your health coverage.

If you are in a high-risk profession such as construction or spend lots of time on the road, you'll want to make certain your emergency room copay is one you can afford. Unfortunately, many accidents and serious illnesses strike without warning, so try to find affordable coverage with a reasonable copay or coinsurance percentage.

Using an online comparison tool can simplify the process. Policy Scout can help you find the best health insurance policy for your needs, including your ER and urgent care coverage. By just entering your zip code and a few basic facts, you will receive numerous policy options. You'll be able to compare the coverage levels and out-of-pocket costs of these options and choose the one that gives you the best protection at an affordable price. Without Policy Scout, you can easily overlook excellent health insurance choices.

Final Thoughts

When you suddenly fall ill or are injured, your first instinct may be to go to the ER. But often, heading to the hospital is not the best choice. Unless you are in danger of permanent harm or are experiencing a life-threatening event, you should try an urgent care facility instead. Most have extended hours that let you receive care during most of the day and evening. You'll receive excellent care more quickly than you would in an emergency room and often at about a quarter of the price. to limit their costs, some insurance policies actually limit payouts for ER visits if the company feels the visit wasn't really an emergency.

You do want to choose a policy that gives you emergency room coverage that you can afford. You should not hesitate to seek this help if you are experiencing severe chest pain, extreme bleeding, difficulty breathing, etc. Choosing emergency room care or urgent care is a judgment call, but most informed patients can determine which option is best for their specific situation.