When to Use Urgent Care Centers vs. Emergency Rooms: A cost-saving guide to help make the right decision during non-emergency situations?

Urgent Care vs. ER: Cost-Saving Guide for Non-Emergency Decisions

Hospital ERs and trauma centers are a necessity for every city.

They’re also costly.

If you’re uninsured, the cost of an ER visit and ambulance ride can run into the tens of thousands of dollars.

And even if you have insurance, you’ll still pay significant out-of-pocket costs in the form of deductibles, and co-insurance.

Insurance companies even impose much higher copays on ER visits than on, say, urgent care center visits and doctor appointment visits – especially if the ER visit doesn’t result in an overnight hospital admission.

The reason insurers do this is to disincentivize unnecessary ER visits, which drive up costs for the hospital, insurance carrier, and everyone else in your plan.

For that reason, it’s best to reserve hospital emergency departments for the most urgent cases threatening life, limb, eyesight, or the loss of a major bodily function.

By saving ER visits for true medical emergencies, and using urgent care clinics and primary care doctors and seeking care at the most appropriate level, you can potentially save thousands of dollars in out-of-pocket costs per visit.  

In this newsletter, we’ll discuss the specific circumstances under which each tier of care is most appropriate, whether it’s the ER/trauma center, an urgent care clinic, a doctor’s office visit, or a virtual/ telemedicine appointment. . 

Knowing this information will help you make informed decisions about when to use each facility or service.

Knowing the Cost

 According to actuarial information from UnitedHealthCare, the average emergency room visit costs around $2,600.

The average visit to an urgent care clinic costs just $185. 

Even with insurance or a healthsharing plan, your out-of-pocket costs for an emergency room visit will typically be much higher than they would be for an urgent care visit or an office visit with your primary care doctor.

It’s therefore to your benefit to seek care at the lowest appropriate level.

However, don’t delay care if waiting means your medical situation could get worse!

For example, a severe allergic reaction on a Saturday night may warrant an urgent care clinic or ER visit right away, for a steroid or ephinidrine shot and other treatment. Don’t wait until Monday to save a few dollars when the need for care is urgent now.

Understanding the Tiers of Care

When it comes to acute and emergency care, here are the basic levels of medicare you should be aware of, and when you should consider using each one. 

Emergency Rooms

ER visits are best reserved for truly severe and life-threatening conditions.

It’s appropriate to visit an ER if you or someone you know is experiencing symptoms such as chest pain, difficulty breathing, severe bleeding, sudden or severe pain, changes in mental function such as confusion or unusual behavior, and other signs of serious illness or injury. 

You should also go to the ER if you suspect poisoning, exposure to harmful substances, or if you’ve suffered a serious injury, such as a head injury or broken bone. In general, if you think your life or health is in danger, the ER is the place to go.

Ambulances

Ambulance services are sometimes necessary. But they’re also very expensive.

A ride in an ambulance to an ER can cost as much as $1,300. Those are hard costs you or your insurance or health sharing plan incur before you even get in the door of the ER.

Even with insurance, you will likely pay hundreds of dollars out of pocket for an ambulance ride.

Call an ambulance for the same conditions as you would go to the ER for, especially if you or the patient is unconscious, has difficulty breathing, or any other condition that prevents them from getting to the ER safely without an ambulance. 

In some cases, you might even need immediate medical attention or lifesaving measures on the way to the hospital. Examples include situations with severe bleeding or amputation, possible heart attack or stroke symptoms, anaphylactic shock or other severe allergic reactions, overdoses requiring Narcan or airway blockage, and/or loss of consciousness.

Urgent Care Clinics

Urgent care clinics are suitable for situations that require prompt attention but are not life-threatening. 

This category can include minor injuries like sprains, burns or minor fractures, flu-like symptoms, urinary tract infections, vomiting or diarrhea, minor allergic reactions, or minor cuts that may require stitches. 

Furthermore, urgent care centers usually have much shorter wait times compared to hospital emergency rooms. On average, urgent care wait times are usually 30 minutes or less. In contrast, hospital ERs typically have wait times of two hours or longer, except for the most urgent cases. 

What types of ailments are best treated in an urgent care clinic?

Urgent care clinics are a great option for anything that is not a threat to life, limb, bodily function, or eyesight, but that need prompt medical attention and cannot until your next available doctor’s appointment.

Examples include:

• Backaches
• Painful urination
• Minor infections
• Rashes
• Minor pain in the knee, ankle, shoulder, neck, lower back, wrist, or foot
• Nosebleeds
• Small objects stuck in eye
• Minor cuts and punctures that may require stitches or debridement
• Headaches/migraines

Go straight to the ER and bypass urgent care if you have symptoms of a possible heart attack or stroke, or for injuries that threaten life, limb, or eyesight, or the loss of a major bodily function.

Doctors’ Office Visits

Minor injuries and conditions can best be handled via your primary care doctors’ office or local clinic.

Many local clinics and family care/general care practices offer walk-in services – especially if you go early in the morning.

Regular check-ups and preventative care, follow-up visits, management of chronic conditions, non-urgent concerns about symptoms, and consultations about health risks or lifestyle changes are best addressed in a scheduled visit with your primary care provider.

You should also schedule a doctor’s visit for vaccinations and regular screenings for health conditions.

Note: Some doctors’ offices will take walk-ins on a limited basis during business hours – especially if you’re already a regular patient. This is another good option that is much less expensive than urgent care or ER visits. It may not be available to you on nights and weekends.

Many health plans provide incentives to patients to use the level of care most appropriate for their condition. For example, it’s common for health insurance or health sharing plans to charge much lower co-pays for urgent care centers and doctors’ office visits compared to ER visits.

Also, many plans charge a much higher copay for ER visits that do not result in overnight admission to the hospital. So if there’s a good chance you won’t be admitted to the hospital overnight, you might be better off using an urgent care center, or making an appointment to see your own primary care physician. 

Telemedicine

Telemedicine is suitable for non-emergency situations where you require advice, a prescription refill, or minor diagnosis that does not require a physical examination. 

Examples include mild symptoms of common illnesses like colds, allergies, minor rashes, or questions about chronic disease management.

Telemedicine is also suitable for mental health consultations or for follow-up appointments that do not require in-person examinations.

Many plans, including most healthsharing plans and nearly all direct primary care plans, include unlimited free telemedicine visits with a board-certified physician. 

In nearly every case, a telemedicine appointment is much more affordable than an ER visit or even an urgent care visit. 

If the patient is not in immediate or acute distress and the medical incident doesn’t require in-person medical intervention such as a steroid anti-inflammatory injection, ephidrine, or stitches/wound dressing, telemedicine may be the way to go. 

IMPORTANT

Warning: If you’re unsure about the severity of a health issue, it’s always better to err on the side of caution and seek immediate medical attention.

If you are legitimately having heart attack or stroke symptoms, or symptoms of any other life-threatening illness, go directly to the ER.

Conclusion

In conclusion, understanding when to use the ER and when to seek a lower, more cost-efficient level of care is important to managing your overall costs. 

By using the most suitable level of care – whether it’s the emergency room, an urgent care clinic, a telemedicine consultation, or a traditional doctor’s visit – you ensure that you get the right care, at the right time, and at the right cost. 

This knowledge empowers you to make decisions that not only safeguard your health, but also protect your financial wellbeing.

Remember, your health is a lifelong journey, and it’s one that requires continual learning and adaptation. As we navigate this complex healthcare landscape together, we hope that this article has clarified some of the paths available to you.

Please feel free to share this information with family and friends who might also benefit. Stay proactive, stay informed, and above all, stay healthy.

And if you ever need anything related to your health insurance, health sharing plan, DPC, HSA, HRAs, or Medigap plans, our Personal Benefits Managers are here to support you every step of the way!

Your PBM’s contact information is at the bottom of this email. Please don’t hesitate to reach out.

Thank you for subscribing, and have a great summer!

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To your health and wealth,

Wiley P. Long, III
President - HSA for America

The HSA for America Maximize Your HSA Newsletter is published monthly and emailed to subscribers at no charge. Subscribe now to stay on top of the critical information you need to know about health insurance, healthshare plans and managing your finances to achieve financial security.