When Should You Rely on Urgent Care?

Individual and Family

When Should You Rely on Urgent Care?

Published on June 18, 2019


Whether you’ve felt the sudden onset of a sore throat or suffered a minor injury on a weekend, you’ve probably wondered whether or not you should try to get an appointment with your primary care provider or go to an urgent care facility.
Keep reading to see information about what urgent care is, some of the suggested times to go there instead of the ER or a doctor’s office, and the costs that might be associated with certain visits to health care facilities, but do not rely on this article as medical advice. eHealth is a private online health insurance exchange, and we are not an official source of medical advice.

When should I go to urgent care?

Going to an urgent care facility for treatment may appeal to those who:

  • Have non-life threatening symptoms of an illness that need to be addressed same day
  • Have minor non-life threatening injuries that need to be addressed same day
  • Need a prescription, minor injury, or other treatment same day and cannot get an appointment with their primary care physician

Urgent care is a great option for those who need treatment same day for a non-threatening injury or illness. If you need care on a weekend or after your primary care provider’s hours of operation, urgent care may be your best option as they usually have evening and weekend hours.
Most urgent care facilities typically will take in walk-ins, however some allow you to make an appointment in advance online.
Most urgent care facilities have x-ray machines and can perform some services that you can typically get from a primary care provider or emergency room. However, urgent care facilities lack the equipment and staff to treat life threatening conditions.
In the event that you experience a life threatening illness or injury, you should consider visiting the ER, and not an urgent care facility.
Additionally, according to an article published in JAMA Internal Medicine, relying on urgent care facilities may lead to inappropriate treatment. This article states that retail clinics and other urgent care facilities prescribe more unnecessary antibiotics than any other setting. Antibiotic prescriptions will not help a viral infection and can cause harm through side effects and, in cases of overuse, can lead to bacterial resistance.

Are urgent care visits covered by my insurance?

While all ACA compliant plans are required to cover 10 essential benefits, including emergency care, urgent care may not be considered emergency care in some cases.
However, most plans do cover urgent care center visits. Patients can be expect to pay a copay or deductible for visits to urgent care facilities. According to Debt.com, urgent care visits cost around $150 on average, which is usually covered but you may pay a copay from anywhere from $35 to $100, on average. They are cheaper than ER visits which mark up their cost upwards of 1000 percent, according to a Johns Hopkins study.
In some cases, your insurance may not cover urgent care or an urgent care facility may choose not to accept your insurance even if your insurance would cover your visit otherwise.
If you’re not sure whether or not your health insurance plan covers urgent care visits, check your plan details as soon as possible, or ideally before you enroll in your health insurance plan.

When should I go to my primary care physician?

It is recommended that you go to you primary care provider over urgent care when you can as a study conducted by the University of Michigan Health System showed that continuity of care has shown to increase patient satisfaction.
While you may not have access to a primary care physician during nights or weekends, unlike urgent care, primary care physicians can offer you continuity of care and other services that urgent care simply cannot.
Unlike urgent care, primary care physicians can

  • Keep and update your medical history
  • Has access to medical records and health history which helps ensure you get appropriate and consistent care
  • Develop a relationship with patient; help reach health goals
  • Coordinate treatment with specialists if needed
  • Provide preventative care

Are primary care provider visits covered by my insurance?

Yes, primary care provider visits are usually covered by your insurance. The ACA requires health plans to cover 10 essential benefits, this includes preventative and wellness services as well as chronic disease management. If you choose a plan such as short term, or accident insurance, you will likely not get covered for primary care visits.
Keep in mind that health insurance companies choose how they cover these benefits, so check plan details before enrolling in a plan, or assuming that your health insurance plan covers primary care visits.
Typically with an ACA or major medical health insurance plan, you can expect your doctor visit to be covered with a copay, or else you will pay for it out of pocket and the cost will go towards your deductible.
Additionally, if you are uninsured physician’s offices typically accept cash, check, and credit cards, along with insurance for payment.
This article is for general information and should not be relied on as medical advice.  Check with a medical professional for medical advice. eHealth is a private online health insurance exchange where individuals, families and small businesses can compare health insurance plans with various levels of coverage. eHealth not an official source of information for healthcare advice or information.

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