Emergency Room vs. Urgent Care: Differences, Costs & Options

October 24, 2022

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differences in services & costs

The discussion of receiving treatment in a hospital emergency room versus treatment in an urgent care center is worth having for anyone concerned about medical debt, especially families, who may have many “emergency” needs. ” and “urgent” that they face every day. year.

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There are many sides to the debate, but the generally agreed-upon guidelines for deciding between an emergency room and an urgent care center are:

Reading: How expensive is the er without insurance

If you have a minor condition (fever, flu symptoms, allergic reactions, minor cuts, bites, broken bones), urgent care centers are a much better option for time and cost.

if you have an extreme medical condition (stroke, heart attack, severe burns, electric shock), the resources and services available in hospital emergency rooms make it a much better option.

Unfortunately, if you’re looking for timely data to support either argument, you’re out of luck. Almost all information on emergency room care is from 2016 or earlier, and data for urgent care centers comes from observation by the American Academy of Urgent Care Medicine.

Still, it’s safe to say that if you have a condition that isn’t life-threatening, urgent care centers can handle it more cheaply and quickly. if life-threatening, better go to an emergency room.

emergency rooms

According to the Centers for Disease Control and Prevention (CDC), Americans made 145 million visits to one of the nation’s nearly 5,000 emergency rooms in 2016. About 23 million of them came by ambulance. approximately 43% of all hospital admissions originate from an emergency room.

Typically, emergency room patients receive one of five levels of care. level 1 is for minor problems, such as ear pain. level 2 may be for a cut that requires stitches, while level 5 is for more serious problems, such as a broken bone. there are levels of care for critically ill patients that are even higher.

The main reason so many emergency room visits are for non-urgent care is that federal law requires hospital physicians to provide care to all patients, regardless of their ability to pay. Because they cannot be turned down, patients without insurance or the funds to pay out-of-pocket costs often use emergency rooms as their primary health care provider. This puts enormous pressure on professionals and limits their ability to respond quickly to health emergencies.

It is estimated that more than $18 billion a year could be saved if patients whose medical problems are considered “avoidable” or “non-urgent” took advantage of preventive or primary care and were not dependent on providers for their care. needs.

what are urgent care centers?

Urgent care centers are a valid bridge between your primary care physician and emergency room services. evolved in the 1990s to serve the 73% of Americans who say they don’t have access to their primary care doctors at night or on weekends.

no appointment is necessary at the approximately 9,300 urgent care centers in the us. uu. they are usually open seven days a week until 9 p.m. or after. Centers are staffed primarily by emergency room and family care physicians and can duplicate nearly all services offered in a traditional doctor’s office or emergency room with two main exceptions:

Do not keep medical records as expected in a primary care physician’s office.
they do not have the sophisticated medical equipment and staff experience found in hospital emergency rooms to manage life-threatening conditions.

urgent care centers have x-ray machines, lab tests, and most of the equipment needed to treat medical conditions ranging from simple things like flu shots or blood sugar tests to more sophisticated treatments like casts for broken bones.

Nearly all of his procedures are covered by insurance and the average cost is $100 to $150 per patient.

Outpatient clinics are similar to urgent care centers, only they are usually staffed by nurses instead of doctors. that limits the services they can offer, but generally speaking, if you need a shot, treatment for a cold, the flu, or a minor sprain, you can get it at a walk-in clinic. outpatient clinics are located in pharmacies, supermarkets and points of sale.

choose emergency room or urgent care center

The discussion of whether to go to an emergency room or an urgent care center for after-hours medical treatment should revolve around the cost and severity of the patient’s condition, but surprisingly, the final decision it is often taken for convenience.

People want medical treatment anytime and anywhere they can get it. With 5,000 emergency rooms providing treatment 24 hours a day, 365 days a year, emergency rooms are the most convenient option.

The most recent data available on costs, time, resources, and effectiveness of emergency rooms is more than three years old. The Centers for Disease Control and Prevention (CDC) said there were more than 145.6 million emergency room visits in 2016.

While the American College of Emergency Physicians reports that 92% of emergency visits are from “very sick people who need care within 1 minute to 2 hours,” the National Hospital Ambulatory Medical Care Survey estimates that one-third to one-half of all emergency room visits are for non-urgent care.

The New England Institute of Health said that 56% of emergency room visits were “totally avoidable.” it did not say how much of the remaining 44% might have been treated in urgent care centers, but several studies suggest that many of these cases might have been treated in urgent care. In fact, the top three reasons for emergency room visits in 2019 were chest pain (4.3 million visits), upper respiratory infections (2.5 million), and urinary tract infections (1 .5 million).

therefore, the decision to receive treatment in an emergency room is one of the many reasons that Americans spent $3.65 trillion on health care in 2018. It is also a factor why more than 75 million of people complained that they had trouble paying off medical debt. which happens to be the no. 1 case of bankruptcy in the us uu.

Some of the problems of debt could be avoided if people knew more about emergency rooms, urgent care centers, and walk-in clinics and how they care for those who need medical care.

when to choose the emergency room

The real question that needs to be answered when deciding between urgent care centers and emergency rooms is: why do I go?

If the answer is: “because I have life-threatening injuries or symptoms,” then the choice is simple: go to an emergency room. otherwise, an urgent care center should do it.

The problem is that some ailments and symptoms straddle the line and only a trained medical staff member could make the decision. if it’s too close to call, common sense dictates going to an emergency room.

There is no definitive list of ailments that require emergency room treatment. Generally speaking, if the condition could permanently affect or threaten your life, it is an emergency.

some of the most common reasons for going to an emergency room are:

severe chest pain
severe abdominal pain
wheezing or shortness of breath
paralysis
intestinal bleeding
high fever or rash, especially among children
vaginal bleeding during pregnancy
repeated vomiting
poisoning
serious head or eye injuries
allergic reactions
unconsciousness

typical ailments of care in emergency centers

There is also no set list of conditions that suit urgent care centers. The general rule of thumb should be that if the condition is not life-threatening, but needs treatment today, go to an urgent care center.

conditions most frequently associated with this include:

fever, flu or cold symptoms
ear infections
animal or insect bites
seasonal allergies
bronchitis
sprains and broken bones
cuts and bleeding that may require stitches
vomiting or diarrhea
respiratory discomfort, such as mild asthma
urinary tract infections
x-rays and lab tests
abdominal pain
mild back pain

again, if the situation is life-threatening or the patient shows symptoms of a life-threatening condition, such as difficulty breathing, loss of consciousness, or unresponsiveness, call 9-1-1 and let an ambulance take you to the emergency room. they could receive medical care while riding in the ambulance that could mean the difference between life and death.

time and time; cost please urgent care

The cost of hospitals alone should be enough to encourage people to go to urgent care centers. Average urgent care visits range from $100 to $150, depending on the patient’s copay and level of treatment, according to dr. franz ritucci, president of the american academy of emergency medicine.

dr. Ritucci said that 70% of patients in urgent care centers use health insurance and their only cost is a copay. uninsured patients face additional charges for things like x-rays, injections, lab tests, or casting a broken bone. As a result, the costs of your care may be much higher.

Average emergency room costs vary greatly by treatment, but a study by the Institute of Health Care Costs put the average cost at $1,389 in 2017.

Then there is the time factor. patients in the urgent care center are seen on a first-come, first-served basis and on average less than 30 minutes from the time they arrive until they leave.

Emergency rooms treat patients based on the severity of the condition. patients with life-threatening injuries go first. the average time from arrival to departure is 2 hours and 15 minutes.

cost estimates for emergency rooms versus urgent care centers

Medica Choice Network has prepared the following cost estimates for nine of the most common reasons people visit the ER. were determined by calculating the average number of claims submitted in 2010 to the Physician Choice Network, a system of more than 4,000 physician offices, clinics, and hospitals in four Midwestern states.

The Annals of Internal Medicine study found that the average cost of an urgent care visit for three common illnesses (middle ear infection, pharyngitis, and urinary tract infection) was $155. other estimates put the average urgent care visit between $71 and $125. The bottom line is that an urgent care visit is substantially cheaper than a visit to the ER.

prudent layman standard

There is another important factor consumers should consider when deciding whether to go to an emergency room or an urgent care center for treatment: the prudent standard of the average person.

the brief definition of the prudent person standard (pls) is: “any medical or behavioral condition that would lead a prudent person, possessing an average knowledge of medicine and health, to believe that the seriousness of his condition would result in death or damage to a physical organ.”

insurance companies use pls as a barometer to determine if a trip to the emergency room was really necessary and how much of the bill, if any, they will pay.

Insurance companies have denied coverage to patients who went to an emergency room for non-urgent procedures such as a cough, sore throat, or sprained ankle. If you could have received treatment at an urgent care center or outpatient clinic, your insurance may not cover it and you would have to pay for treatment out of pocket.

That could mean more credit card debt or taking out a personal loan to cover an expense that would have been paid by insurance if you had visited an urgent care center.

The prudential person standard allows for discretion in borderline cases. If you experience symptoms related to a serious condition (shortness of breath, rapid heartbeat, dizziness, or fainting) and went to an emergency room, the claim should be covered, even if the final diagnosis was that it was not a serious condition.

This is another step by insurance companies to reduce emergency room claims for frivolous medical conditions. however, if you believe your claim is a legitimate emergency room visit, and you are still denied, there is an appeal process. a 2011 study by government accountability offices showed that 39-59% of appeals were successful.

go to the hospital without insurance

The good news about going to the ER is that you’ll get treatment, whether you have insurance or not. the bad news is that you will be charged later, whether you can pay or not.

The Emergency Medical Treatment and Active Labor Act, a federal law passed in 1986, requires that anyone presenting to the emergency room be stabilized and treated, regardless of insurance status or ability to pay. it applies to all hospitals that accept medicare and since almost all hospitals do, it effectively includes them all.

The average cost of an emergency room visit was $1,389 in 2017, according to a study by the Institute of Health Care Costs, which reviewed millions of claims over a 10-year period.

Who pays the treatment bill if you don’t have insurance? the federal government provides funds to hospitals to treat the poor, but not enough to cover the full cost.

Studies show that, for the most part, hospitals foot the bill themselves in what they call “uncompensated care.”

However, patients will be charged, and in many cases, medical bills will be turned over to collection agencies, who will attempt to recover at least a portion of the bill.

can i visit the emergency room without insurance?

The answer is yes, you can go to an urgent care center without insurance and get treatment, but if you can’t afford it, you might be denied.

Urgent care centers are not subject to the Emergency Medical Treatment and Labor Act and most require some form of payment at the time of service. the typical charge at urgent care centers is between $100 and $150.

How much you are expected to pay depends on the level of treatment you receive. many urgent care centers post a price list so you know the cost in advance. some will offer discounts if they know you don’t have insurance.

how emergency room costs add up

The recent introduction of high deductible insurance makes it possible for individuals and families to take on serious medical debt if they have to use an emergency room.

The Kaiser Family Foundation says that in 2017, 91% of Americans are insured, but many are on high-deductible plans. the high-deductible plan required patients to pay an average of $1,217 before insurance coverage kicked in. many high deductible insurance policies are closer to $2,500 for individuals and $5,000 for families.

If an emergency room visit requires X-rays, an MRI, lab tests or complicated procedures, the total cost could easily exceed your deductible and, depending on your coverage, a portion of the remaining bill will be your responsibility.

And that’s if you went to the emergency room yourself!

If you had to use an ambulance service to get to the emergency room, you could be charged anywhere from $25 to $1,200, depending on whether you have insurance and what type of plan you have.

There’s also a chance that the emergency room you choose may be out of network. even if you choose an in-network hospital, you may still see an out-of-network doctor and have to pay that cost. the uninsured would have to pay the entire bill out of pocket.

7 tips for paying emergency room bills

So what should you do if the bill for an ER visit is more than you can afford?

here are some suggestions to fix the problem:

talk to the billing department. there are several sets of costs for the same procedure at most hospitals. ask them to bill you at the lowest cost available. then ask about other types of concessions they might make.
Ask for an itemized accounting. Errors happen on emergency room bills. it could be for medications that were never administered, procedures that were not performed, etc. ask your primary care doctor or nurse to review the bill and see if all the items make sense for the procedure you had.
Ask for a payment plan. Hospitals don’t want the bill to go to a collection agency. tell them how much you can afford each month and see if they’ll work with you.
financial assistance programs. Ask the hospital if they are aligned with any charities that offer financial assistance to people who need help with medical bills.
bill crowdfunding. There are online crowdfunding sites like giveforward.com, fundly.com, and youcaring.com that are specifically aimed at helping people manage medical debt. if the bill hits the five-figure price range, post your story on a crowdfunding site and see how people are willing to help.
Consider bankruptcy. There’s a good reason why medical debt is the no. 1 cause of bankruptcy. If you go to an emergency room for a catastrophic situation and are hospitalized, your debt load can quickly become unmanageable. consult with a bankruptcy attorney. medical debts are not guaranteed and can be discharged in a successful bankruptcy filing.
Talk to a nonprofit credit counselor. It’s generally not a good idea to consolidate medical debt unless you owe other creditors. Credit counseling agencies may be able to consolidate all your debts into one payment.