Save Time and Money by Choosing The Right Level of Medical Care

The average ER visit costs 10 more than the same treatment in an urgent care clinic, and 20 times what it costs in your doctor’s office. But about 30 percent of E.R. visits or more are better suited for urgent care or doctor’s office visits, according to industry research. [i]

 ERDoctor’s office, urgent care clinic
Average Total Cost$1,917 +
Average patient out-of-pocket cost (with insurance)$364 [ii] -$560 [iii]$35-$41 [iv]
Average wait time2 hours, 15 minutes30 minutes

Ultimately, all plan members pay for unnecessary E.R. visits: Group health plan premiums are based on actual usage, spread out among plan members. Reducing needless ER visits will translate into lower premiums for all plan members and for the company.

Some insurance plans deny claims for ER visits if a prudent layperson would clearly have elected a more appropriate level of care.

The E.R. is for Emergencies

For true emergencies, go to the ER, of course. That means for anything that threatens life or limb or that may need an immediate surgical intervention. But many common health conditions can be dealt with much faster and more efficiently in your doctor’s office, or in a neighborhood urgent care clinic.

Here’s why: Your doctor already knows your medical history and treatment preferences. An ER visit for a minor issue may mean hours in the waiting room and a big bill. But an office visit often gives you better continuity of care – with little or no waiting – and at a fraction of the cost.

When to go to the E.R.

  • Life-threatening conditions
  • Heart attack or stroke symptoms
  • Severe shortness of breath
  • Coughing or vomiting blood
  • Uncontrollable bleeding
  • Suspected overdose or poisoning
  • Seizures
  • Chest pain
  • Severe asthma
  • Severe stomach pain
  • Sudden blurred vision, weakness, dizziness or loss of balance
  • Sudden severe headache with no history of migraines
  • Numbness in arm, leg or face
  • Fractures when bone is protruding through skin
  • Severe burns
  • Labor pains or vaginal bleeding if pregnant
  • High fevers
  • Anything that you believe may be life threatening

When to see your doctor

  • Cold and bronchitis symptoms
  • Migraines
  • Sore throat/strep
  • Moderate fevers
  • Rashes
  • Back pain
  • Urinary tract infections
  • Earaches
  • Pinkeye
  • Minor cuts and lacerations
  • Sprains
  • Prescriptions
  • Chronic disease management (diabetes, high blood pressure, etc.)
  • Any health issue where you need advice from someone who knows you

Generally, these are not appropriate for the E.R.

When to use an urgent care clinic

An urgent care clinic frequently has an X-ray machine and other diagnostic equipment on site. These are usually best for:

  • Minor broken bones (no bone protruding from skin)
  • Minor eye injuries
  • Moderate asthma attacks
  • Minor cuts and burns
  • Vomiting/diarrhea
  • Any ailments normally appropriate for your doctor’s office but that cannot wait until business hours.

Questions? Call the number on the back of your insurance card, or ask a nurse by dialing ___________.

Permission is freely granted for any Kadalyst client to include this piece in any employee or beneficiary-facing newsletter or Intranet/portal. Non-Kadalyst clients, please call ______ Kadalyst assumes no liability for any information included in this newsletter article.

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