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It is 7pm at night and you burn your hand while cooking dinner. Your doctor’s office is closed but you are pretty certain that your burn needs to receive some sort of medical attention soon. Should you go to the Emergency Room that is close to your house and most convenient or should you try to go to a Convenience Care Clinic at your neighborhood grocery store or go to the Urgent Care Clinic about 15 minutes away? Maybe you can just wait until the morning and try to get an appointment to be seen by your doctor.
It is generally known that a visit to the Emergency Room costs more than a trip to a Physician’s office for the same ailment/treatment, but most employees and employers do not realize just how different the costs between the various care options really are. Choosing the most appropriate option can save employees from paying higher copays and deductibles and it helps to keep the employer’s annual claims costs down as well. Since lower claims can positively influence the renewal rates for the next policy period, it is vital that everyone understand the available options for care so they can make an educated decision about what is best for their particulate sickness/injury.
Below is an example of what an average visit at various care options could cost for someone without health insurance:
Some Emergency Room trips are certainly needed & warranted based on the severity of the issue, however in the US, every year a substantial number of visits that occur at the ER are for situations which are not life threatening and where alternative treatments could have been provided for a far lower cost.
For example, a medium size business could see their claims reduced by almost $25,000 just by encouraging employees to utilize Urgency Care over an Emergency Room when appropriate. Collectively employees could also save up to $5000 a year in copays or more for plans that have deductibles for ER visits (based on 20 trips a year).
Emergency Room
These are facilities operated out of a hospital and other primary care centers that are typically open 24 hours a day. They are capable of handling severe and life threatening injury or illness. While the ER can handle virtually any problem, trips in general should be reserves for issues such as heavy bleeding, difficulty breathing, major burns, severe head injuries, internal injuries, convulsions/ seizures, severe chest or abdominal pain, pregnancy complications, sudden changes in vision or severe eye injuries, large open wounds, loss of conciseness, poisoning, spinal injuries, severe infections, severe allergic reactions, high fever or major broken bones.
Any case where an individual’s life could be reasonably at risk or the severity of the situation is not known, it is always best to err on the side of caution and visit the ER over other care options.
Emergency Rooms under a medical plan are usually subject to either copays ranging from $250 – $450 per visit or to the plan Deductible plus 20%-50% Coinsurance.
Urgent Care Centers
A level below an ER is an Urgent Care Center. These will typically have a medical doctor on site at all times during operational hours and commonly utilize Nurse Practitioners (NPs) or Physician Assistants (PAs) to assist patients. These facilities usually have extended hours, are open 7 days a week, and do not require appointments.
Instances where an Urgent Care trip would be appropriate include: Sprains & strains, minor burns, urinary tract infections, minor allergic reactions, fevers and/or flu, back pain, seasonal allergies, minor infections, vomiting and/or diarrhea, minor cuts requiring stitches, moderate asthma/ breathing discomfort, and minor broken bones.
Urgent Care Centers under a medical plan are usually subject to either copays ranging from $75-$100 per visit or to the plan Deductible plus 20%-50% Coinsurance.
Primary Care Physician Office
This would be either an individual’s Primary Care Physician or a physician’s office that handles general care on an as needed basis. This could be an independent office, or part of a larger group network. A doctor is usually onsite, but it is also common for PA’s or NP’s to treat patients as well. Many offices are open regular business hours (9-5), 5 days a week. These offices can generally handle everything that can be done at an Urgent Care Center, but at a lower cost. Most offices do require an appointment, so they are best when the matter does not require immediate attention.
Reasons to visit a Physician’s office are the same as an Urgent Care with the addition of a basic annual check up and/or preventative care. Preventative care (such as an annual wellness checks/exams) are covered under most medical plans at 100%.
Physician Offices under a medical plan are usually subject to either copays ranging from $20-$70 per visit or to the plan Deductible plus a copay of $25-$50.
Convenience Care / Retail Clinics
These are typically found inside of stores like Walmart, Target, CVS & Walgreens, but are also becoming more common in grocery stores as well. They are usually staffed by a PA or NP without a doctor on site. These clinics have similar, or slightly reduced hours than the retails stores they are in, and may or may not be open 7 days a week. They do not require an appointment and are better for minor issues that need attention.
Common reasons to visit a Convenience Clinic include sore throat, earache, sinus infection, flu shot, common cold, upset stomach, bug bites, minor fever, minor rash, coughing, & congestion.
Convenience Clinics under a medical plan are usually subject to either copays ranging from $40-$60 per visit or to the plan Deductible plus a copay of $20-$40.
Telemedicine
This is becoming more common as a care option for employees covered under medical plans. Telemedicine, also commonly called Virtual Visits, is when you speak to a healthcare professional through a computer, phone, or tablet. This is an alternative to an in person trip when a diagnosis rather than a physical treatment is needed. Virtual visits may occur with a doctor, NP, or PA and are often available 24 hours, 7 days a week. Telemedicine can be used for many of the same ailments that Urgent & Convenience Care can handle. It is also good as an initial option for those in rural areas who don’t have quick access to other facility options.
Common reasons to use telemedicine include minor allergies, fever, pinkeye, sinus infection. Cough/cold, diarrhea, rash, sore throat, congestion, urinary tract infections, flu or stomach ache.
Telemedicine / Virtual Visits under a medical plan are usually subject to a lower copay than a regular Physician office visit ranging from $10-$20 per visit.
In Summary
It is important to educate employees on their options and stress that choosing the most appropriate option for care will not only save them money on copays and deductibles, but can also help to keep the group premiums from significant increases at the end of the policy period. It is suggested to compile a list of several Urgent and Convenience Care facilities in the area, along with their hours of operation and recommended services they can handle for employees to use as a general reference. Distributing information about the availability of telemedicine and how to access it will also help to encourage employees to use lower cost options for care for minor issues.