Inevitably, from time to time an illness or an accident can happen. You might think about going to an urgent care center and wonder whether your insurance will cover your expenses. The answer is usually yes, but there’s a few things to keep in mind beforehand. Let’s look a little more about what urgent care means and when urgent care is covered by insurance.
When is Urgent Care Covered?
Insurance coverage for urgent care service is determined by each individual insurance provider. In most cases, insurance providers do cover urgent care, but you will need to pay a deductible or a co-payment. Very rarely, an urgent care center will decide not to accept your insurance, even if you are covered. It’s a good idea to call ahead and confirm that the urgent care center will accept your insurance.
How Much Does Insurance Pay for Urgent Care?
An urgent care patient will typically be charged a $20 to $40 co-payment for routine, in-network care. With routine, out-of-network care the co-payment may range from $35 to $100, depending on the urgent care center. Your insurance provider will bill you if you still owe money after your medical services are completed.
Is Your CoPay Higher for Urgent Care?
Many insurance companies will charge a larger co-pay if you choose to go to an urgent care center rather than your primary care physician.
One reason is because urgent care centers usually have a higher overhead cost than a traditional physician’s office. Most regular physician’s offices set appointments and can plan their schedule ahead of time, but an urgent care center must be prepared for a number of medical scenarios at any given time.
Another reason is that urgent care centers routinely do diagnostic testing and lab work for their patients, which can add to their expenses. This leads the insurance companies to base their co-pay on the estimated cost of your visit, which is likely to cost more than a routine visit to your primary care physician.
So, although a trip to an urgent care center is more expensive than visiting your primary care physician, it’s important to note that it’s still cheaper than going to the emergency room. An emergency room has an extremely large overhead and must keep a staff of specialists, nurses, and surgeons on call, as well as keep in stock and maintain specialized equipment for diagnoses and treatment.
What Services Does Urgent Care Provide?
Generally, urgent care centers provide treatment for non-life-threatening injuries and illnesses. Some examples of conditions that are treated may include:
- Pink eye
- Colds and flus
- Allergic reactions
- Strep throat
- Sinus infections
- Ear infections
- Animal and bug bits
- Cuts and burns
- Broken bones, sprains, and strains
Many urgent care centers also offer a wide variety of lab services in conjunction with treatment and diagnostics. These kinds of lab services are like what you would find in an emergency room or at your primary care doctor’s office. Some lab services offered may include:
- STD testing
- Pregnancy testing
- Drug testing and screening
- Flu and rapid flu tests
- Strep test
- Electrolyte testing
- Fecal blood occult
- Blood tests such as complete blood counts (CBC), basic and complete metabolic panels, and blood glucose
Urgent care centers also frequently provide routine preventative treatment for patients. These services can include:
- Physicals for school, sports, summer camp, or annual
- Drug screening
- Flu shots
- Gynecological exams
- Well baby checks
The staff at all urgent care facilities are medical professionals who are able to take your medical history and give you the best treatment possible. This may sometimes include giving you medication on-site or starting an IV. You also may be offered a prescription for any necessary medication once you have a diagnosis and treatment.
When to Go to an Urgent Care Center
At times, you may feel that something is wrong, but you’re not sure what is the appropriate action to take. If you don’t have an obvious injury, but you are experiencing any of the following symptoms, it’s a good idea to find an urgent care facility and get yourself checked out:
- Nausea, diarrhea or vomiting
- Rashes or itching that won’t go away
- Sore throat
- Body aches or muscle aches
- Unexplained pain or swelling
- Coughing, sneezing, or wheezing
When to Go to the Emergency Room
Emergency rooms are best for when you have a true medical emergency. Most emergency rooms are a part of a hospital that is open 24 hours a day and can handle any life-threatening situations such as trauma or emergency surgical procedures.
It’s important to note that if you have a life-threatening situation, you need to call 911 or get to an emergency room as soon as possible. An urgent care center probably will not be equipped to handle a true emergency. You should choose to go to an emergency room instead of an urgent care center if you experience:
- Difficulty speaking
- Sudden dizziness
- Sudden loss of coordination
- Sudden numbness or weakness
- Shortness of breath
- Asthma attack
- Loss of consciousness
- Heart attack, intense chest pressure, or chest pain
- Uncontrolled bleeding
- Severe burns or cuts
- Sudden loss of vision
- Head injury
- Severe allergic reaction
- Major trauma
- Vomiting or coughing blood
Online Urgent Care Treatment
Online doctors are becoming more and more popular as healthcare costs rise in the United States. With an online doctor you can see a doctor via phone or video chat and get your prescription sent straight to your pharmacy.
Will your insurance cover an online urgent care appointment? It depends. If your insurance covers telemedicine, you will be in good shape, and only have to pay a copay. If not, you will have to pay out of pocket.
Think you may be interested in an online urgent care appointment? Click here to book an appointment with a PlushCare physician and see a doctor today!
PlushCare takes content accuracy seriously so we can be your trusted source of medical information. Most articles are reviewed by M.D.s, Ph.D.s, NPs, or NDs. Click here to meet the healthcare professionals behind the blog.