In the Texas Community

Blue Promise: Where You Go Matters

When you need to see a doctor, where you go matters. Primary care physicians, urgent care clinics, free standing emergency rooms and hospital emergency rooms can all be very different – especially when it comes to how much money you spend.  In this episode of Blue Promise, Dr. Dan McCoy and Dr. Paul Hain talk about the best options for different types of health conditions and medical emergencies.

Blue Promise is an online video blog that aims to address complicated health issues with candid conversations from subject matter experts.  New editions are published regularly and are hosted by Dr. Dan McCoy, Blue Cross and Blue Shield of Texas' Chief Medical Officer and Divisional Senior Vice President of Texas Market Strategy.

Show Transcript

DAN: Hello I'm Dr. Dan McCoy and welcome to This episode of Blue Promise. I'm here today with Dr Paul Hain who is our Chief Medical Officer for North Texas Blue Cross and Blue Shield of Texas

PAUL: Right

DAN: So Paul, whenever people call the doctor's office they, always get that message that says if this is an emergency dial 911

PAUL: Right

DAN: Well what do you do, how do you make that choice?

PAUL: Yeah so there are things that are real emergencies like chest pains, strokes and things like that in which case, you don't really need to call your doctor's office for, you just call 911, but for most of us for most everything else there's really a decision to be made about how urgent is this problem and do I need to go to an emergency room right now or can it wait or where should I go and so finding out where to go is really important and that the first step is calling your Physician, that's the person that has the best relationship with you and that's a person could really guide you the most so if you can get in to see your primary care doctor, that's the best place to go. If you can't get in then you have a choice to make, you can go to an emergency room which is usually quite a long wait and it ends up costing a lot of money both to yourself, out of your pocket and the insurance company or you can head to an urgent care center where generally the wait is not nearly as long and the care is excellent and it is cheaper for everyone all around

DAN: So, what would be an example of say care you might get from an urgent care center?

PAUL: Sure, so say you had a cold for a couple of days now you have a fever and you're worried it's sinusitis, that's a great time to go.

DAN: Stitches? What happens if I need..

PAUL: Most simple stitches can be done in urgent care centers and at a tremendously lower rate and the outcome is just as good and you'll be in and out quite a bit faster so cuts, bruises, colds, flu like symptoms, things like that, urgent care is great

DAN: Ok so I have To bring this up, drive down the freeway you're gonna see a lot of these new entities, freestanding ERs

PAUL: Oh, the free standing ERs

DAN: so what is that?

PAUL: so that's where you know, you and I grew up thinking of emergency rooms as being attached to a hospital most of them still are but sometimes you'll see these ERs in strip malls or stand alone in a parking lot and it's functioning just like an emergency room they have all the same stuff they have emergency room doctors and they function just like an emergency room which means when you go to one you're gonna get charged like an emergency room

DAN: So they're not urgent care centers

PAUL: They are not urgent care centers And so it really isn't And they look like them So it's important to really ask when you get there or call ahead and say are you an emergency room or are you an urgent care center? Because the difference To your pocketbook is going to be astounding

DAN: like give me an example?

PAUL: Where you might get charged for $500 as your share in free-standing ER and even worse if they're not part of your insurance company's network you might end up paying the whole bill into the tune of thousands of dollars as opposed to a copay for an urgent care center that is going to be more on the $5,200 range.

DAN: For a rather simple problem.

PAUL: For a very simple things

DAN: So we recently did a study here at Blue Cross, and we looked at people who go to the emergency room about services that could have been done in other settings and we saw that we pay about thirty million dollars a year here at Blue Cross and Blue Shield of Texas, on services that could have been done in other settings. So why is it important to an average consumer?

PAUL: You know, it's important for two reasons One, if we're spending that much money that doesn't need to get spent, eventually someone has to pay for it and so it goes back in people's premiums going up Right? and nobody likes that and secondly, patients have a share of the bill that they have to pay, the bigger the bill the bigger the share so not only are they paying on the front end they are pay more right out of the pocket but eventually, they end up having to pay more in premiums as well

DAN: So really, where you go matters

PAUL: Where you go matters

DAN: Paul, thanks for being here and thank You for joining us for this episode of Blue Promise.

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