Need To See A Doctor Afterhours? The Differences Between Emergency Rooms And Urgent Care Clinics

If you are sick or injured and an ambulance is called, you're headed for the emergency room. But, what happens if you have a minor injury or just feel sick when your regular doctor's office is closed? Should you head for the emergency room or seek help at one of the urgent care centers in your area? Below are the differences between the two services, which may help you decide.

Emergency Rooms and Urgent Care Clinics Explained

Emergency Rooms

Emergency rooms are located in hospitals, are open 24/7 and are the best places to go for severe and life-threatening illnesses and injuries. They have round-the-clock access to diagnostic testing facilities, laboratories and operating rooms. Doctors in almost every specialty are on an on-call basis and they supplement the doctors and nurses already on site.

On the downside, wait times at emergency rooms can be long, especially if your injury is not as serious as others. Those brought in by ambulance usually take precedence, if only for an initial check.  Medical costs at emergency rooms are also much more expensive.

Urgent Care Clinics

Urgent care clinics, sometimes called neighborhood walk-in clinics, are located in various places around a city or metropolitan area. The larger the city, the more clinics you're apt to find. As of the latest Foundation Health Care survey, in 2013, the Los Angeles-Long Beach-Santa Ana area in Southern California, had 164 clinics. The Phoenix-Mesa-Scottsdale area, in Arizona, is less populated but still had 80 clinics.  

Most urgent care centers have extended hours and are usually open evenings and weekends. Some are staffed around the clock. Many have on-site labs and diagnostic equipment. If your condition is very serious, they usually refer you to the emergency room. The two biggest differences are shorter wait times—patients are usually seen in order of arrival—and less expensive fees.

How Your Insurance Covers Emergency Room and Clinic Costs

Most insurance companies cover emergency room and urgent care clinic costs differently. This usually affects your out-of-pockets costs.

Co Pays

Since medical fees at emergency rooms are higher, chances are your deductible on a covered charge will be higher. For example, if a certain service at an urgent care clinic is $300 and your co-pay is 10 per cent, you'll end up paying $30 for that service. At an emergency room, that same service may cost $1000. You'll end up shelling out $100, if your insurance covers emergency room care at all.

Multiple Charges

At an urgent care clinic, you'll have one bill covering the physician's fee, treatment and visits. Insurance companies pay a percentage of the bill, according to your coverage. At an emergency room, you're likely to get at least two bills, one from the physician who treated you, the other for the hospital visit. Other charges may trickle in, especially if you've had major diagnostic tests, such as an EKG. Not all charges may be covered, depending on your plan.

Emergency or Not

Some insurance companies don't pay for emergency room visits if they decide your illness or injury wasn't serious enough. In that case you may have to pay most or even the entire bill. That usually happens when people come in for routine medical care, like a quick check-up for a prescription renewal. That is something best handled at a clinic.

The billing departments at hospitals and at insurance firms do tend to be reasonable. They understand that most people don't really know if their issue is serious and may come in, just in case. But, if you show up looking for a vaccination or routine check-up at an emergency room, be prepared to pay the price.