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January 15, 2018

Urgent Care vs ER Copay

Emergency rooms such as Frontline ER are an excellent place to get care for emergency medical conditions. However, you may have to wait for ages if you have a non-emergency medical condition. The ER is designed to serve patients depending on how severe their condition is and charge for access to their wide range of facilities. When you visit an urgent care center, the costs can be a quarter of what you pay at the hospital or half of your visit costs to the doctor. Let us examine the copay at these two types of medical facilities.

Time and Cost are in Favor of the Urgent Care Centers

An average visit to the urgent care center will cost $50 to $150. This is especially so if you have insurance. On average, 70% of patients who visit the urgent care center will have insurance and only have to think about the copay. Uninsured patients will have to incur costs for shots, x-ray, lab tests, or casting. Thus, costs for them can be quite high.

ER visit costs will vary depending on the treatment sort. However, a study conducted in 2013 found that the median cost was at $1,233. Some other studies put this figure at $2,168. The location is a major factor in this.

The other issue is time. Patients who go to the urgent care centers are seen on a first come first serve basis. In most cases, a doctor will attend to them 30 minutes after they step into urgent care. At the ER, it can take 15 minutes or 2 hours to have a doctor attend to you. This is because patients are attended to depending on the severity of the condition.

Understanding the Prudent Lay Person Standard (PLS)

The PLS is something that each patient who visits the ER needs to think about. According to this standard, it is any condition would lead a layperson to conclude that their condition could lead to death or harm to their physical organs.

Insurers will use this standard when determining whether the patient’s visit to an ER was necessary and how much of that bill they should pay. In some cases, insurers will refuse to pay for the cost of patient visits that they consider non-urgent. If you visit the urgent care center or a walk-in clinic for cases such as a sore throat, the insurer may agree to pay for it. If you go to the ER, the insurer will refuse to pay, and you have to pay for it out of pocket.

This will usually mean more credit card debt, or you have to take out a loan to cover the expense, which would have been paid by the insurer if you had gone to an urgent care center. According to the PLS standard, your insurer could still cover you even when the case turns out to be minor. For instance, if you had shortness of breath, dizziness, short breath or fainting, that may be considered.

Insurers, to avoid paying for frivolous visits to the ER, put this measure in place. However, if you believe that you have a legitimate claim, you can still appeal. In fact, about 39%-59% of all appeals were successful, according to a study conducted by the Government Accountability Office.

Tips for Paying at the ER

  • Ask for itemized billing

With an itemized bill, you will be able to view mistakes conducted by the ER. This could include being billed for medication not issued. Talk to your GP and ask them if the costs for which you were billed make sense.

  • Contact the billing department

At any ER, there are usually different sets of costs for the same procedure. Always ask the department to bill you at the least possible cost they offer.

  • Request for a payment plan

The ER and especially those attached to hospitals will have a payment plan. Most of them do not want to have to send your bill to a collection agency. Tell them that you can afford to pay a certain amount every month and see if they will agree to work with you.

  • Consider crowdfunding

Today, numerous crowd-funding sites help those with major medical bills. If you have a bill that is in the five-figure zone, put your story up on one of these sites. You may be surprised at the overwhelming amount of support that you receive.

  • File for bankruptcy

Medical bills are the leading cause of people filing for bankruptcy. If you visit the ER and are hit with a major bill, your debt could become unmanageable. Before filing for it, talk to an attorney. Since medical debt is unsecured, it is likely that your bill could be dismissed if the bankruptcy filing succeeds.

Summary

In some cases, the copay can be high at the urgent care center than at the ER. However, if you have a major emergency, it is always best to go the ER, they will usually have better facilities to deal with these cases.

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