Turn right or left? Take the wrong road and you could run into high ER charges

Turn right or left? Take the wrong road and you could run into high ER charges

Convenience care facilities are popping up all over town. You see them in retail shopping centers and on every street corner. We’ve all had the experience of needing medical attention outside of a scheduled doctor’s visit. But not all of these facilities are created equal. There are important differences between an urgent care center and an emergency care center.

Urgent Care Centers

When you need immediate medical attention, but it’s not life-threatening, urgent care centers may be the answer. They typically are open on extended hours such as evenings, weekends and holidays. At an urgent care center, you can be treated for flu, sprains, animal bites, migraines, back pain, and get stitches and x-rays. The cost of an urgent care center is more than your doctor, but it’s less than an emergency room charge. Check your health plan to see what your co-pay is for urgent care.

Now, if you see the word “Emergency” on the building or store front (no matter how small the building is), that facility is not an urgent care center, but rather an emergency care center.

Emergency Care Centers

In year’s past, emergency rooms were always part of hospitals. When you drove up, you would look for a 24-hour emergency room sign and maybe you’d see an ambulance parked nearby. Did you know that there are emergency facilities not located inside of or affiliated with hospitals?

In the last five years, emergency room centers have been opening at record pace in strip malls, shopping centers and in neighborhoods. These ERs are not located inside a hospital. Some may be part of a hospital system serving your area, but most are private companies.  

At first glance, these freestanding emergency care centers look similar to urgent care centers. They are equipped to address medical emergencies – and they also charge emergency room prices. We all know that getting medical care in a hospital setting is the most expensive. That’s why we only visit a hospital in the event of a true emergency. The same is true for these emergency care centers. Even though they are not located inside of a hospital, they still charge those emergency prices.

Why is this important?

So what does this all mean for you? In short, significant out-of-pocket costs.

Besides having to pay the highest cost of care, typically freestanding emergency care centers do not contract with insurance carriers like Blue Cross and Blue Shield of Texas.

 This means, they can charge whatever they want and leave the insured (you) vulnerable to “surprise bills” (also known as balance billing). The bills that come in long after you have recovered exceed the cost of seeking care at your doctor’s office or an urgent care center.

If you visit one of these facilities with an urgent (non-emergency) medical issue such as a cut that needs stitches, a sprained ankle, the flu or an ear infection, you’ll likely pay a hefty price.

When you visit these ERs, you may be told that they accept your insurance coverage. They may even have it on a sign outside their building. What that really means is that your insurance covers emergency care at any ER, even if they aren’t in your health plan’s network. What they don’t tell you is that they aren’t in your plan’s network, so they can bill you for anything your health plan doesn’t pay. Because their charges are so high, this could leave you owing a lot.

You Have Options

Where you go for care matters. It’s important to know your options for care so you can determine what the most appropriate setting is for the type of treatment you need.

You can’t plan for an emergency, but you can learn about what’s available when it isn’t one. Just like you may have participated in a fire drill, you can plan and prepare. In a true medical emergency, you should seek immediate care at the nearest emergency facility. When your care is simply urgent, take stock of your options; consider calling your doctor first for advice (even after hours and weekends).

To find out what urgent care centers near you are in your health plan’s network, use Provider Finder…

As a health care consumer, you have the right to get the answers you need to manage your medical concerns, without mismanaging your pocketbook. Want to learn more? Take a look at our Health Care Costs series to learn more about what goes into each dollar you pay for medical care.