Urgent Care or ER: How to Choose the Right Place for Immediate Medical Attention

The thousands of Urgent Care centers that dot the American landscape, together make up one of the strongest pillars of the entire healthcare sector. When immediate medical attention is required, Urgent Care facilities are the first choice. Of course, many of us can choose to visit a hospital Emergency Room (ER) or a walk-in clinic instead. But it is important to understand that the choice of where we go to receive a medical service or treatment, will determine how good the chances are to get reimbursed by our Health Plan eventually. This is because all these different places are qualified to address specific medical needs.

So, for example, if one requires a flu shot, or wants to get tested for COVID-19, or is in need of immediate care for a minor, non-life-threatening injury – the best place to visit is an Urgent Care facility. Visiting the ER is not recommended under such circumstances, which is better suited for more serious and life-threatening conditions like a major surgery, a stroke, severe burns or the like. It is important to bear in mind that Emergency Room costs can be typically 6x – 8x the cost of visiting an Urgent Care Center. For a hospital Emergency Room, facility fees average between $500 and $2,000. And, this does not include the hospital bill!

Naturally, your Health Plan will be interested in ensuring that no unnecessary costs have been incurred by the patient or the provider. In other words, it will try to determine if the patient’s case could have been addressed in an Urgent Care setup instead of an ER. The insurer will reimburse only if it is fully satisfied on that account. This is the reason why so many claims frequently meet with denials or rejections because they are submitted as a hospital bill when they actually qualify for Urgent Care billing.

It is interesting to learn that 71% of ER visits could have been avoided with a visit to an Urgent Care facility. However, one should also bear in mind that hospital Emergency Rooms operate 24/7 and provide overnight treatment and monitoring. Such services are beyond the scope of typical Urgent Care services which remain open only during specific hours of the day.