Emergent vs. Urgent - Planning Ahead for the Minor Stuff

If your health plan is like most, it offers a persuasive disincentive to visit the emergency room when an urgent care center will do. This disincentive often takes the form of a higher 
co-payment for emergency care. (The 
co-payment is your share of the cost.) Moreover, if you go to an emergency room for an ailment that seems questionable as an “emergency”, the insurance company may deny the claim, leaving you on the hook for the entire bill.

PPACA (i.e., “Obamacare”) defines a medical emergency as symptoms which would cause a reasonable layperson to fear that an absence of immediate care could mean a loss of life, limb, or organ; or the loss of function in a limb or organ.

Generally speaking, emergency rooms are connected to hospitals. They are heavily staffed, expensively equipped, and never closed. Patients typically wait for hours to see a doctor. Emergency rooms treat major traumas, broken bones, heart attacks, uncontrollable bleeding, unconsciousness, and the like.

Urgent care centers, by contrast, are free-standing facilities, lightly staffed, less equipped, and open later than normal business hours (but not open all night). Patients typically wait a matter of minutes, not hours, to be see a physician’s assistant or nurse practitioner. Urgent care centers treat flu symptoms, fevers, chills, sprains, headaches, and the like.

One of the most common reasons policyholders go to the emergency room for symptoms that do not meet the PPACA criteria above is a lack of planning. Nevada Benefits recommends that you take a moment now, while you are well, to locate the urgent care centers nearest your home and place of employment; then make a note for future reference. Waiting until you are sick or injured before mapping your way to the nearest urgent care center will prove more difficult than doing so in advance of your actual need.

Of course, if you experience a medical emergency, then you should call 911 or go to the nearest emergency room. Otherwise, an urgent care center, if appropriate to the ailment, can save you money, time, and aggravation.   

Do not hesitate to contact us with any questions about the emergent and urgent care benefits under your plan.