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Primary Care Physician vs Urgent Care vs Emergency Room

It’s eight o’clock at night. You’re cutting vegetables when you accidentally take a chunk out of your finger. There’s blood everywhere.

Assuming the finger isn’t severed and you haven’t cut an artery, your first instinct is probably to reach out to your family doctor. At seven or eight at night, you may or may not get a return phone call, but either way, it’s unlikely that he or she will see you right away.

When deciding between Urgent Care or a visit to the Emergency Room, it benefits you and it benefits the Writers Guild Health Plan when you make the best decision for your particular circumstances. It’s no fun sitting in an Emergency Room for hours on end, waiting to get treatment. When your injury/illness isn’t life threatening, the ER is an expensive, time consuming endeavor. Urgent Care does a faster and less expensive job – when it’s the right solution.

You could call 911 for your bloody finger, perhaps go to an Emergency Room, or you could visit an Urgent Care center. 911 is expensive. If you go that route, it means an ambulance trip to an Emergency Room. Even with your Writers Guild Health Plan you may be responsible for up to $2,800 dollars. Typically, the cost for ambulance service to an Emergency Room is $1,200 or more. And when you get to the Emergency Room, the medical staff are going to perform triage to see who gets helped first. You’re not having a heart attack. You’re not in immediate jeopardy of death. You’ll be lucky to get out of there by midnight, with a few stitches and a large bill (click here to see typical scenarios).

The cost of Urgent Care treatment is typically one half to a third of what an Emergency Room costs. The average time from walk-in to exit at Urgent Care centers runs around 45 minutes. If you’re not sure where the nearest Urgent Care center is located, you can find Urgent Care centers in your area by clicking here.

Here’s an example taken from an actual file. The Participant had stomach pains, went to the ER, waited a very long time, and incurred a high bill. The Plan also paid a much higher amount as a result of going to the Emergency Room rather than Urgent Care.

Constipation (Out of Network)

Bill Type Billed Amount Patient Paid*
Emergency Room $8,043.03 $2,657.91

* Parient Paid includes $50 ER copay, $300 deductible and coinsurance

Each year, the Plan spends over a million dollars on Emergency Care, and a significant portion of those visits are better suited to Urgent Care. Making the best decision for your circumstances can help save money – for you and the Health Plan.

Frequently Asked Questions (FAQs)

Urgent Care is faster and cheaper than Emergency Care. But when is it appropriate? And when should you see your personal physician?

See FAQs below:

What Is Considered an Emergency Situation?

According to the American College of Emergency Physicians, you should visit the ER if you have any of the following warning signs:

  • Chest pain or pressure
  • Uncontrolled bleeding
  • Sudden or severe pain
  • Coughing or vomiting blood
  • Difficulty breathing or shortness of breath
  • Sudden dizziness, weakness, or changes in vision
  • Severe or persistent vomiting or diarrhea
  • Changes in mental status, such as confusion

If you have a chronic condition, discuss in advance with your primary care doctor under what circumstances you should go to the ER.

What is Considered an Urgent Medical Condition?

Urgent medical conditions are ones that are not considered emergencies but still require care within 24 hours. Some examples of such conditions include:

  • Accidents and falls
  • Sprains and strains
  • Moderate back problems
  • Breathing difficulties (i.e. mild to moderate asthma)
  • Bleeding/cuts — not bleeding a lot but requiring stitches
  • Diagnostic services, including X-rays and laboratory tests
  • Eye irritation and redness
  • Fever or flu
  • Vomiting, diarrhea or dehydration
  • Severe sore throat or cough
  • Minor broken bones and fractures (i.e. fingers, toes)
  • Skin rashes and infections
  • Urinary tract infections

Urgent Medical Care vs. Emergency Room for Young Children

Head straight to the ER if:

  • Your child is less than 2 months old and has a fever. Fever is defined as a temperature 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
  • You suspect your child has a broken bone, particularly if there is visible swelling or unevenness and bumps in the injured area — a sign that the broken bone is misaligned.
  • Your child hits his head and appears to pass out or lose consciousness for a few seconds
  • Your child has had a seizure
  • Your child has signs of dehydration, such as very dry lips and mouth, absence of
    urination for more than 12 hours, lethargy and confusion
  • Your child has heavy, fast breathing, is gasping for air or manages to utter only two
    or three words before taking a breath.
  • Gaping cuts on the face, especially in younger children who need sedation or
    behavioral support while the laceration is being repaired.

Consider Urgent Care when you can’t see your pediatrician within a day or two and if:

  • Your child has fever accompanied by cold symptoms and you suspect it may be the flu.
  • You suspect your child may have an ear infection; symptoms include drainage from the ear, ear ache and pulling on the ears.
  • Your child has a sore throat with or without white patches on the tonsils, a possible sign of strep infection.
  • You suspect your child may have pink eye, also known as infectious conjunctivitis, symptoms of which include red, inflamed eyes with or without discharge.
  • Your child has had a few episodes of vomiting or diarrhea (without blood in the stool) but has no belly pain or signs of dehydration.

Dr. Therese Canares, an emergency physician at Johns Hopkins Children’s Center, recommends, “As a rule, if your child is able to walk, talk, interact and play, chances are whatever she or he has is not an emergency.” Canares also advises calling the Urgent Care clinic ahead of time to ensure they treat infants — many have age limits — and describing your child’s symptoms. “Ask them if based on the age and symptoms, they are comfortable evaluating your child,” Canares says. “And do ask to speak with a clinician, rather than the receptionist. The last thing you want is to show up at the clinic with a sick kid only to be told you should make your way to the ER instead.”

The most important thing to keep in mind when deciding between Urgent Care and Emergency Room treatment is that if you are in doubt, get emergency care.


Examples of Typical Costs of Emergency Room vs. Urgent Care

The proper usage of Urgent Care saves the Participant time and money, and it also helps the Plan stay financially healthy.

In the examples below, not only does the Participant save money by the proper use of Urgent Care, but doing so also saves the Plan thousands of dollars.

Urinary Tract Infection (PPO Provider)

Facility Billed Amount Patient Paid
Emergency Room* $14,763.48 $161.94
Urgent Care $170.00 $15.59

* Patient Paid includes an Emergency Room copay of $50

Bronchitis (PPO Provider)

Facility Billed Amount Patient Paid
Emergency Room* $4,934.87 $156.82
Urgent Care $355.00 $32.53

* Patient Paid includes an Emergency Room copay of $50

Allergy (Single Patient)

Bill Type Billed Amount Patient Paid
Emergency Room* $1,781.00 $127.25
Ambulance $1,404.50 $280.90

* Patient Paid includes an Emergency Room copay of $50