How to Avoid Overpaying for Emergency Room Visits


 

When you're injured or ill and need immediate treatment, it can be hard to decide whether you should go to the nearest hospital emergency room (ER) or a local urgent care center. But if you keep a few guidelines in mind, you'll be able to choose the most appropriate care for your situation.

Does the choice really matter? Absolutely. Making the right decision can save you time, money and discomfort—or in true emergencies, even life and limb.
 
A report by the Centers for Disease Control and Prevention (CDC) in Atlanta shows that many Americans visit the ER when an urgent care facility would be more appropriate for their needs. Take the 110.2 million ER visits in the United State during 2002, for example. Only 22 percent were considered emergent while 34 percent were urgent, 19 percent semi-urgent and 10 percent non-urgent. The bottom line is that many of the patients crowding hospital emergency rooms should be going to urgent care centers—where they'd get quality care, probably in less time and almost certainly at a lower cost.

But keep in mind the “fast track” of most emergency rooms can be equally expensive. According to insurance company Humana’s website, "All centers are not created equal, and the difference can affect your wallet. To reduce your costs, choose a free-standing urgent care center, one that isn't located in a hospital… Your copayment and other costs could be a lot higher if you choose an urgent care center in a hospital."
 
Health care providers also stress that when patients with non-life-threatening issues choose an urgent care center instead of an ER, it's a win-win situation. “In an ER, a non-emergent patient may have to wait several hours to be seen for a problem that an urgent care center could treat in a small fraction of the time and money,” said Dr. David Zahaluk, medical director of Main Street Medical Care in Lewisville. “At the same time, if more non-emergent patients chose urgent care centers, it would alleviate overcrowding and longer than necessary waits in hospital emergency rooms where seconds count.”
 
So how can you determine whether an emergency room or an urgent care center is most appropriate for your illness or injury? In general, an emergency is a situation that requires immediate medical care to prevent death or impairment.

On the other hand, modern urgent care centers, such as Main Street Urgent Care in Lewisville, TX, differ from a typical primary care physician’s office in having procedure rooms for stitching lacerations and splinting bone fractures, a nearby radiology department for X-ray services and other diagnostic imaging tests, and a laboratory for onsite lab tests like quick strep tests, rapid flu tests, pregnancy tests, tetanus shots, cholesterol tests and other blood work.  They also can provide breathing treatments for asthmatic patients, high blood pressure stabilization, ear lavage and IV therapy.
 
But Can I Trust Them With My Health?

Putting your trust in a health care provider is a serious matter, emergency or not. Consumers should be sure a center's health care professionals are well trained and experienced. A center's location, convenience and comprehensiveness of care are also important factors. And to paraphrase Patch Adams, “healing should be a human interaction, not a business transaction.”

Avoid “pill mills” whenever possible. The ultimate gauge of an urgent care center is their commitment to excellent care. “Our patients have lots of good things to say about us,” says Dr. Zahaluk, of Main Street Medical Care. “I believe the main reason is that we commit to treating all of our patients with 100% courtesy, dignity and respect,” he said.
 
Will My Insurance Cover an Urgent Care Visit?

Not only do most insurance companies pay for services rendered at an urgent care center, most actually encourage their use through the use of lowered co-payments for urgent care centers as opposed to emergency departments. That's because most insurance companies now recognize the significant cost savings benefit of the urgent care center over hospital based services.  

  

Most insurance companies evaluate clinics and providers before accepting them into their network of approved health-care providers. So if your insurer or another insurer covers them, that's a good sign. Typically urgent care centers list the insurances they accept on their websites. For a list of insurances accepted at Main Street Medical Care, go to www.MainStreetMedicalCare.com.

Wait Times Matter
 
Studies show that fewer than 20 percent of the population even have what they could call a personal physician. Of those who do, less than 12 percent of the people who need a doctor are able to get an appointment the same day they need one.  Many people don’t get the care they need because they either don’t know where to go to get good care or they don’t want to wait hours to be seen.
 
“Quality is most important. The most costly visit is the one that results in the wrong diagnosis or treatment.   Once you are satisfied that you are getting quality care, wait time is often the key differentiating factor in choosing an urgent care”, says Dr. Zahaluk.  
 
Look for urgent cares that track their wait times and communicate them to patients. At Main Street Medical Care they go a step further guaranteeing your wait time will be an hour or less or your visit is free. They accomplish that by tracking the internal efficiencies of their practice and typical volumes and staffing accordingly.

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