When illnesses or injuries strike, people often wonder if they should go to urgent care or straight to the emergency room. And, for many patients, cost plays a big role in their decision. The difference in urgent care vs. emergency room cost depends on several factors that we will explore. From insurance to the services being rendered, we’ll break down the basic differences between urgent care and emergency room costs.
Why is There a Difference in Cost?
Urgent care centers and emergency rooms serve different purposes within healthcare systems. Urgent care facilities are designed to handle medical issues that require prompt attention, but that are not life-threatening. Minor injuries, respiratory illnesses, infections, and skin conditions are among some of these. In contrast, emergency rooms are specially equipped to address critical or life-threatening conditions, such as severe trauma, heart attacks, strokes, or those that require immediate medical intervention.
Cost of Urgent Care Visits
Urgent care facilities offer cost-effective, prompt treatment options for minor illnesses and injuries. The upfront cost of urgent care visits are typically significantly lower than those of emergency room visits. The differences are primarily due to: insurance plans, the nature of the visit, and services rendered.
Urgent care also focuses on primary care services outside of regular office hours, or in place of an appointment with your primary care provider. Xpress Wellness Urgent Care offers virtual primary care services and in some clinic locations they also offer in-person primary care services, which enables patients to have continuity of care. Urgent care offices also accept a wide range of insurance plans, which helps reduce out-of-pocket expenses for patients.
Cost of Emergency Room Visits
Emergency room visits themselves are more expensive than urgent care visits, and each individual service provided is billed separately. For example, diagnostic imaging, blood work, or specialist consults are all subject to their own fees. But, these services are indispensable in a true emergency, so it’s important to recognize when you need to go to the emergency room.
When an Emergency Room Visit is Needed
If you’re experiencing a medical emergency, you should always head to the closest emergency room. Emergency rooms are equipped to treat life-threatening symptoms and injuries, and can admit patients straight to the hospital. On the other hand, urgent care is for sudden or uncomfortable illnesses and injuries that are non-life-threatening.
The following symptoms or injuries should always be evaluated in an emergency room:
- Profuse bleeding
- Compound fractures (where the bone has broken through the skin)
- Altered mental state
- Slurred speech
- Sudden and severe headaches
- Difficulty breathing
- Chest or abdominal pain (especially when accompanied by shortness of breath)
- Severe allergic reactions
- Loss of consciousness
This is not a comprehensive list, and anytime you feel symptoms that are debilitating or severe, you should be evaluated in the emergency room – regardless of the financial implications.
Insurance Plays a Major Part
Ultimately, urgent care vs. emergency room cost comes down to insurance plans. Some plans offer special copays or coinsurance costs for urgent care visits in order to encourage patients to utilize this option. This not only reduces costs for patients, but also keeps non-emergent visits to the emergency room at a minimum so that hospitals are available to treat true life-threatening situations more readily.
If you look at your insurance card or plan, you’ll most likely see copays for urgent care and emergency room visits. Urgent care visits are billed similarly to primary care visits, but will typically carry a slightly higher copay. For example, if your primary care provider copay is $20, it’s normal to see a $40-$65 copay for urgent care visits. But the same insurance plan may carry a $350 copay for an emergency room visit.
If your insurance plan does not require copays, you will be billed according to your deductible. This usually means that you will be responsible for paying a negotiated office visit amount that is dependent on your insurance plan and provider. Once your deductible has been met, you’ll pay a certain percentage of urgent care visits going forward. For urgent care, this translates into an appointment in the hundreds of dollars range – but this amount could be thousands of dollars for an emergency room visit.
Other Factors to Consider
Aside from the financial aspects of healthcare visits, it’s important to consider the effects of non-emergent visits to the emergency room. When a non-life-threatening illness or injury is evaluated and treated in the emergency room, it requires doctors, nurses, medical equipment, time, and space – all of which burden the healthcare system. True emergencies that come into a hospital’s emergency department may not receive timely care if its triage beds are occupied by other patients.
To avoid this unnecessary strain on hospitals and financial stress for patients, always weigh the severity of your discomfort or symptoms before deciding between urgent care and the emergency room. If over-the-counter medications offer relief, and you’re able to rest through your discomfort, an urgent care visit is likely your best option.
Xpress Wellness Urgent Care Visits
Xpress Wellness Urgent Care offers online check-in to reduce your wait time in the office. Or, receive urgent care from the comfort of your home with virtual urgent care visits, which are conducted conveniently and securely through a video meeting with one of our skilled providers. We offer multiple types of health services, and have locations across Oklahoma and Kansas to bring you affordable and accessible healthcare. Save time and money when you choose Xpress Wellness Urgent Care for your healthcare needs, and avoid surprise hospital bills from an emergency room visit.
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