If it's a serious injury, heart attack, major burn or gunshot wound, it's probably safe to say you should head straight to the nearest hospital’s emergency entrance. Some hospital systems are also starting to build stand-alone emergency centers. They act just like the hospital ER and cost the same, but are located in suburban areas.
When considering your time, money and – especially – your health, it's important to know your options. The good news is that you have choices for receiving in-network care that work with your schedule and give you access to the kind of care you need. Know when to use each for non-emergency treatment and when it's necessary to go to the ER.
Convenience is a big check in the win column when it comes to being able to get quick care close to home, but maybe an even bigger bonus is the cost. A visit to a retail health clinic costs around $25. Urgent Care Center visit copays are about $65.00. An ER visit? You’re looking at over $500 out of your pocket, not counting the cost of X-rays, stitches, and other services. A ride to the ER in an ambulance could add another $1,500 or more to your bill.
In fact, an Institute of Medicine report from 2012 said that around 56% of emergency room visits are not actually emergencies, which wastes more than $38 billion each year nationwide. Who pays for that? Essentially, you and I do, through higher insurance premiums that cover the overall costs of care.
Why do people head straight to an ER when they need care? Fear, for one, especially when it comes to a sick child. I know I tend to overthink every decision that impacts my child’s life and well-being. It’s easy to panic and head to the ER. Another reason is convenience, as we’ve already mentioned, especially late at night or during the weekend when the doctor’s office is closed. Habit, unfortunately, is also to blame. Some people use the ER as if it’s a doctor’s office – never taking the time to establish a relationship with a doctor or medical group for ongoing care needs.
Overall, I believe it’s about knowing where to go when you need care. Before you get in the car, consider which road you will take: Before you get in the car, consider which road you will take:
Your doctor's office is generally the best place to go for non-emergency care such as health exams, colds, flu, sore throats and minor injuries. Seeking treatment from your doctor will often result in lower out-of-pocket costs than either an urgent care facility or an ER.
Your doctor's office may take walk-ins, but it's best to call ahead to see if this option is available. You may need to make an appointment.
If you have an HMO, you should visit your primary care physician (PCP). Your PCP can provide non-emergency treatment or refer you to a specialist if your medical condition requires specialized treatment. If you do not have a PCP, call the number on the back of your member ID card or use Provider Finder to search for a doctor within your plan's network.
Retail Health Clinic
Walk-in clinics are often located in stores and pharmacies and provide convenient, low-cost treatment for minor medical problems like: ear infections, athlete's foot, bronchitis and some vaccinations. Their hours are similar to retail store hours, and their out-of-pocket costs are generally lower than an urgent care facility or an ER. Walk-in clinics are a great option for non-emergencies if you do not have a doctor or cannot get in to see your doctor on a timely basis.
Urgent Care Facility
Urgent care centers can provide care when your doctor is not available and you don't have a true emergency, but need immediate care. For example, they can treat sprained ankles, fevers, and minor cuts and injuries. These are illnesses or injuries that do not pose an immediate threat to your health or life.
Urgent care centers are often open on evenings, weekends and holidays. Medical services at an urgent care facility typically have lower out-of-pocket costs than an ER but may be higher than if you visit a doctor's office or a retail health clinic.
Your local ER is available 24 hours a day, seven days a week and can treat serious illnesses and injuries. For medical emergencies, call 911 first. You may need an ambulance if:
- You need to be moved by medical professionals to prevent further injury
- Your condition is life-threatening or you think it may be life-threatening
- The distance to the hospital would cause a significant delay in receiving immediately-needed medical assistance
In the event of an emergency, it's important to get care at the hospital closest to you. You don't need to get prior approval if the ER closest to you is out-of-network. In many cases, you won't be charged more for these services than you would at an in-network ER.