Urgent care is like a walk-in clinic that can provide the patients with almost 70% of the services provided in the emergency rooms. Both serve the patients facing a medical emergency. However, the selection of urgent care or emergency room solely depends on the severity of the emergency. If it is a life-threatening situation, one should run for an emergency room without having a second thought; otherwise, urgent care is the best solution. Based on their functioning its evident that there would be a cost difference between urgent, which is discussed as
Urgent Care Expenses
Urgent care is more affordable than the emergency room in case of minor emergencies. It has some reasons behind this. All the patients visiting urgent care can wait for their turn; they are not having some extreme emergency. The staff present over there comprise the physician’s assistance, nurses, and rarely the physician. So the charges for treatment are less than the emergency room. Other services provided, such as diagnosis of diseases, Xrays, and blood testing, are also done n a comparatively low cost.
Moreover, the administration does not inquire about the patient’s back history or any appointment. For example, if a person has the flu, the doctors would prescribe them the drugs instead of investigating any allergic reactions in the past. However, that does not mean that the staff is not up to the mark. They are mostly very experienced and immediately recognize patients’ symptoms. In all, the effort done in urgent care on a single patient is not that much, so as a result, it also cost less. An average expense of a patient in urgent care is between $75-$155. It may or may not include the prescribed drugs. The health insurance plans often cover urgent care services.
Health Insurance In Urgent Care
It is a plan offered by the health insurance company by which they fully or partially cover their health care expenses in the case of any health emergency. It includes
Deductible: the money patients have to pay before the insurance company covers their treatment.
Copay: the amount patients pay for their treatment after paying the deductible. For example, if a service charges $200. The copay that one would pay will be $40 in case if that service s covered.
Coinsurance: it is the amount that patients have to pay even after they complete their deductible.
The insurance plans vary because if a plan has a lower monthly premium, then its copay would be high, and if it has a high monthly premium, its copay would be below. According to a survey, an average copay in urgent care is $5-$100, and the average deductible is $99. These insurance plans also cover the prescribed drugs.
Now talking about the insurances and how they cover the cost of services in urgent care, we must consider the type of insurances covering the urgent care. It covers HMO and PPO.
HMO
It stands for health maintenance organization. This type of health insurance plan restricts the patients to some specific urgent care centers or a group of physicians. The health insurance companies sign contracts with different urgent care centers and doctors and pay them a considerable amount affirming that the people availing their insurances would only come to them. Moreover, these urgent care centers has almost all the services covered for the patient visiting them. He does not have to pay the actual amount; instead, he can get his treatment done by paying only the copay.
It provides coverage only inside the network. The patient is not free to go to any urgent care center, or o meet anty physician according to his will. He will only pursue the ones inside his health insurance plan; otherwise, he would have to pay the actual uncovered amount from his pocket if he visits the urgent care outside the network. In an HMO, the patient does not need to file a claim for the coverage. It has a low monthly premium, an average of $427(5124 annually). It does not demand the annual deductible.
PPO
It stands for the preferred provider organization. It does not limit its patient to some specific urgent care or physicians. The patients can go to any urgent care center either from inside or outside the network, and still, their services would be covered by the plan. This plan is helpful in rural areas where the urgent care centers from inside the network are not available, so they can freely go to any nearby available urgent care and be treated. In this case, the patient has to pay for the services first, and then they have to claim the amount’s coverage. It has copay as well as coinsurance with the deductible.
Emergency Room
Emergency room costs more than urgent care because of highly qualified doctors and the best machinery. In emergency care, the patient would be given the best treatment, but it would cost more. The average cost of a visit to an emergency room is from$1300- to $3000.
Health Insurance In Emergency Rooms
According to the Affordable Care Act, insurance has to cover emergency services completely. Over here from emergency services, it is meant that there is a chance of the patient losing his life. The insurance will cover all the services whether the patient went to an out-of-network emergency room. Over here, the insurance company digs into the situation—the severity of emergency matters. If a person in a stable condition gets his treatment done from the emergency room, he would be charged the actual amount that cost the services he enjoyed. If the patient was in a severe condition, the insurance company covers all the charges until the patient becomes stable.
Costs Without An Insurance
The costs of uninsured treatment in urgent care or emergency room is higher than the insured ones. There are many ways by which a patient can take help:
- She/he can negotiate with the doctor about the charges.
- She/he can go for different payment plans by discussing with the administration to not be burdened.
- She/he can also mention his bankruptcy to choose a plan by which he could pay the money in several instalments.
- She/he can ask the doctor to prescribe him the medicine that has the same formula but is manufactured by some other company at an affordable price.