There are differences in services and costs
Anyone concerned about medical bills and families who have many “emergency” or “urgent” issues each year, it is worth having a debate.
There are many sides to this debate. However, the following guidelines are generally accepted for deciding between an urgent care center and an emergency room.
Urgent care centers can be a better option for cost and time if you have minor conditions such as fever, flu symptoms, allergic reaction, or minor cuts, bites, or broken bones.
Hospital emergency rooms are a better option if you have a severe medical condition such as stroke, heart attack or severe burns.
If you’re looking for data that supports either of these arguments, unfortunately, it is not possible. Nearly all information about emergency room care dates back to 2016, and data regarding urgent care centers comes from American Academy of Urgent Care Medicine.
However, urgent care centers are able to handle non-life-threatening conditions faster and cheaper. You should go to the emergency room if it is life-threatening.
The Centers for Disease Control and Prevention (CDC) reports that Americans made 145,000,000 visits to nearly 5,000 U.S. emergency rooms in 2016. 23 million people arrived in ambulances. An emergency room accounts for 43% of hospital admissions.
Normally, patients in an emergency room receive one of five levels. Level 1 can be used for minor issues, such as an earache. Level 2 could be used for minor problems like an earache. Level 5 may be used for more serious issues such as a broken bone. There are higher levels of care for critically ill patients.
Because hospital ERs must provide care for all patients regardless of financial ability, the main reason so many emergency rooms visits are for non-urgent care. Patients without insurance or sufficient funds to cover out-of-pocket expenses and cannot be turned away often use emergency rooms as their primary health care provider. This places a tremendous burden on ERs and reduces their ability to respond quickly to medical emergencies.
If patients with medical issues that are not urgent or unavoidable were to seek primary and preventative care, it is estimated that $18 billion annually could be saved.
What are Urgent Care Centers?
The Urgent Care Centers are a bridge between your primary physician and emergency department services. They were established in 1990 to help the 73% of Americans who said they couldn’t get to their primary care doctor at night or weekends.
The estimated 9,300 U.S. urgent care centers do not require an appointment. The centers are usually open seven days per week, from 9 p.m. to midnight. These centers are staffed primarily with family care and emergency department physicians. They can duplicate almost all of the services provided in the traditional doctor’s office or emergency rooms, with two exceptions.
- They won’t keep your medical history like you would at a primary doctor’s office.
- They don’t have the expertise and sophisticated medical equipment that is found in hospitals emergency rooms for life-threatening situations.
The majority of equipment required for medical treatment, from simple treatments like flu shots and blood-sugar testing to more complex ones like casting broken bones, is available at urgent care centers.
The majority of their procedures are covered under insurance. On average, the cost per patient is between $100 and $150.
Walk-in clinics can be compared to urgent care centers but are usually staffed by nurses instead of doctors. Although they are limited in the services they offer, most people can get a shot or treatment for minor injuries at a walk-in clinic. Walk-in clinics can be found in grocery stores, pharmacies and retail outlets.
Choose an Urgent Care Center or Emergency Room
While the cost and severity of the patient’s condition should be the main considerations when deciding whether to visit an urgent care center or emergency room for after-hours treatment, it is not uncommon that the final decision is made for convenience.
People need medical care at any hour and in any place. Emergency rooms offer the best choice because they have 5,000 locations that provide treatment 24 hours a days, 365 days a calendar.
More than three years ago is the most recent available data on emergency room costs, time and effectiveness. According to the Center for Disease Control and Prevention (CDC), there were 145.6 million emergency room visits in 2016.
The American College of Emergency Physicians states that 92% of emergency visits come from “very sick people” who require care in a matter of minutes to two hours. However, the National Hospital Ambulatory Medical Care Survey indicates that only one-third to one half of all ER visits are for non urgent care.
According to the New England Health Institute, 56% of emergency department visits could be avoided. However, several studies have shown that many of these cases could have easily been managed in urgent care. The top three reasons for ER visits were chest pains (4.3M visits), upper respiratory infections (22.5 million) or urinary tract infections (1.25 million).
The decision to seek treatment in an emergency room is one reason Americans spent $3.65 trillion for healthcare in 2018. This is also why over 75 million Americans reported having difficulty paying off their medical debt. The #1 cause of bankruptcy is the U.S.
It would be possible to avoid some of the debt problems by learning more about urgent care centers, emergency rooms and walk-in clinics. Also, learn how they treat those who are in dire need of medical attention.
How to choose an emergency room
When deciding between emergency rooms and urgent care centers, the real question to ask is “Why am I going?”
If you answered “Because of life-threatening injuries/symptoms”, then your best option is to go to the emergency room. An urgent care center is the best alternative.
Problem is, some symptoms and ailments can be so severe that only a trained medical staffer would be able to make the call. It’s best to go to the emergency room if it is too close.
There are no set of conditions that require emergency room treatment. It is considered an emergency if your life is permanently impaired or endangered by the condition.
Voici les reasons why you might need to visit an emergency room:
- Chest pains severe
- Grave abdominal pain
- Shortness of breath or wheezing
- Bleeding to the stomach
- Children especially are at risk for high fevers and rash.
- Pregnancy and vaginal bleeding
- Repeated vomiting
- Eye or head injuries that are severe
- Allergy reactions
Common Ailments that Urgent Center Care can treat
Also, there is no set of conditions that are suitable for urgent care centers. If the condition is not life-threatening but requires immediate treatment, it should be taken to an urgent care center.
Those conditions are most commonly associated with it include:
- Flu symptoms, fevers and cold symptoms
- Infections of the ear
- Insect or animal bites
- Allergies to seasonal foods
- Broken bones and sprains
- Stitches may be required for cuts and bleeding
- Vomiting and diarrhea
- Moderate asthma can cause breathing discomfort.
- Urinary tract infections
- Lab tests and X-rays
- Abdominal pain
- Back pain
If the patient is experiencing life-threatening symptoms or is in danger, dial 9-1-1 to have an ambulance transport them to the emergency department. The ambulance could transport them to medical attention, which could make the difference between life or death.
Time & Cost are Favorable for Urgent Care
It should not be difficult to find urgent care centers because of the high cost of hospitals . According to Dr. Franz Ritucci (President of the American Academy of Urgent Care Medicine), the average cost of urgent care visits is $100 to $150 depending on the patient’s co-pay, treatment level, and other factors.
Dr. Ritucci stated that 70% of urgent care patients have health insurance. The only cost they pay is a copay. Patients who are not insured may be charged additional fees for shots, x-rays, and casting broken bones. Their care costs can be higher as a result.
The average emergency room cost varies widely depending on the treatment. However, a 2017 study by the Health Care Cost Institute put the average cost at $1389 in 2017.
There is also the issue of time. Urgent care patients are seen in a first-come first-served basis. Patients usually wait less than 30 minutes between the time they arrive and when they leave.
Patients are treated in an emergency room according to the severity of their condition. Patients with life-threatening injuries are treated first. It takes on average 2 hours and 15 minutes to get from arrival to departure.
Cost estimates for emergency rooms vs. Urgent Care Centers
The Medica Choice Network prepared the following estimates for the nine most frequent reasons that people visit the ER. These were calculated by calculating the average number of claims submitted to the Medica Choice Network in 2010, which has more than 4,000 clinics, medical offices and hospitals across four Midwestern States.
According to the Annals of Internal Medicine, $155, is the average cost of an urgent visit for three common conditions: middle ear infection (pharyngitis), pharyngitis (urinary tract infection). Others estimate that the average urgent care visit costs anywhere from $71 up to $125. An urgent care visit is significantly cheaper than an emergency department visit.
Prudent Layperson Standard
Consumers must also consider the Prudent Layperson Standard when deciding whether they should visit an urgent care center or emergency room for treatment.
The Prudent Layperson Standard (PLS), as it is short, refers to: “Any medical condition or behavior that would lead a prudent laidperson with an average knowledge about medicine and health to believe that severe consequences would cause death or injury to a physical organ.”
The PLS is used by insurance companies to gauge whether an emergency room visit was necessary and how much they will have to pay.
Patients who visited an emergency room for non-urgent conditions like a sore throat, cough, or sprained ankle have been denied coverage by insurance companies. You would need to pay out your own money if you were able to get treatment at an urgent care or walk-in clinic.
This could lead to more credit card debt, or a personal loan to pay for an expense that you would have paid for with insurance if your visit was urgent.
Borderline cases are covered by the Prudent Layperson Standards. Even if it is not severe, a claim for coverage should be made if you have symptoms such as shortness of breath or rapid heartbeat, dizziness, or fainting.
Insurance companies take this step to reduce frivolous medical conditions and emergency room claims. If you feel your claim is legitimate and the hospital denies it, there are appeals. According to a 2011 Government Accountability Offices study, 39-59% of appeals were granted.
Without insurance, going to the hospital
The good news is that you can go to the emergency room regardless of whether or not you have insurance. Unfortunately, you will be charged for your treatment afterward regardless of whether you have the funds.
A federal law, the Emergency Medical Treatment and Active Labor Act (a 1986 federal law), requires that anyone who comes to the emergency department is stabilized and treated regardless of whether they have insurance or are able to pay. It is applicable to all hospitals that accept Medicare, and almost all hospitals do.
According to a Health Care Cost Institute study, the average cost of a visit to an emergency room was $1389 in 2017. This is based on a review of millions claims over a 10-year span.
If you don’t have health insurance, who pays the bill? Although the federal government provides funding for hospitals that treat the poor, it is not enough to cover all costs.
Research shows that hospitals pay the bill in “uncompensated care” for most of the time.
Patients will still be charged, and in many cases the medical bills will be turned over to collection agencies, who will attempt to recover at most a portion of the bill.
What if I don’t have insurance and want to visit urgent care?
Answer: “YES”, you can visit an Urgent Care Center with no insurance to be treated. However, if you don’t have the finances to pay they may turn you away.
Urgent Care Centers do not have to comply with the Emergency Medical Treatment and Labor Act. Most require payment at the time of service. Urgent Care Centers charge between $100 and $150.
The level of care you receive will determine how much you’ll have to pay. Most Urgent Care Centers provide a list of prices to help you understand the price upfront. If you do not have insurance, some will give discounts.
How Emergency Room Prices Add Up
The introduction of high deductible insurance has made it possible for individuals and their families to take on significant medical debts if they need to visit an emergency room.
According to the Kaiser Family Foundation, 91% of Americans were insured in 2017, but many are still in high-deductible plans. Patients had to pay an average $1,217 for high-deductible plans before their insurance coverage would kick in. High-deductible insurance policies can cost as little as $2,500 for individuals, and as much at $5,000 for families.
You will be responsible for any portion of the bill if you need to visit the emergency room for x-rays, MRI, laboratory tests, or other complicated procedures.
That’s even if you drive yourself to the emergency department!
Depending on your insurance coverage and the type of plan you have, an ambulance service could cost you anywhere from $25 to $1,200 to transport you to the emergency room.
You may also find that the emergency department you choose is not in your network. Even if the hospital you choose is in-network, it’s possible that you will be treated by an out-of-network physician and must pay for this cost. Uninsured patients would be responsible for the entire bill.