Your Benefits: Emergency Care and Urgent Care

When a pressing medical condition presents itself, your first thought usually isn’t, “What will my healthcare benefits cover?” But that often will be your second or third thought, and knowing the answer can help you make good decisions and save money. Following is some basic information to help you decide where you should turn in urgent medical situations.

The E.R. If someone in your family is facing a life-threatening situation, getting to the emergency room as quickly as possible is essential. The good news is that you don’t have to worry about whether your benefits will cover a trip to the emergency so long as the situation truly is an emergency. The law requires that insurers cover emergency services at the same price regardless of whether the hospital where you seek care is in your network. However, you will be responsible for co-pays and deductibles required under your plan, and you might find yourself receiving bills from individual providers. Also, if you are admitted to the hospital as a result of an emergency, how you are charged could change. On the other hand, if your emergency providers code the care you receive as non-emergency care, or if your insurer decides that your condition was not a medical emergency, you might find yourself facing out-of-network costs if the hospital providing care is not in your network.

Your Primary Care Provider. If your situation is pressing but not an emergency, your first call should be to your primary care provider. They might be able to see you quickly, saving you waits in the emergency room, or at least help you decide where to go for care. One benefit to this choice: Your provider knows your medical background and can treat you in the context of your ongoing conditions and medical history. Making this choice also will be covered by insurance like any other office visit and is much less expensive than a trip to the emergency room.

Urgent Care. For non-emergency care that is urgent or when you can’t reach your primary care provider, urgent care facilities are a great option, but do be mindful of what facility you choose. Most insurers will provide you with a list of urgent care facilities that will provide care at in-network rates. Even if you pay out-of-network rates, urgent care facilities typically offer care at a fraction of the cost of the E.R.

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