What is the Difference between Urgent Care and Emergency Room?
Urgent care can treat minor fractures, nonemergency x-rays, back pain, and cold and flu symptoms. At the same time, the emergency room may treat more severe conditions, such as chest pain, heart attack symptoms, and difficulty breathing.
Whether you go to urgent care or the emergency room depends on the medical situation you are in. If you are in an emergency, you should always go to the emergency room because urgent care cannot provide the level of care you may need. If you are not experiencing an urgent medical situation and the hours are between 8 AM and 5 PM (unless the center is open later or earlier), you may want to consider visiting an urgent care center.
When and Why Insurance Deny Emergency Room Claims?
When patients use non-ER facilities, it’s less costly for the Insurance, and that translates into lower overall healthcare cost—and lower insurance premiums—for everyone. But in the case of a life- or limb-threatening condition, an emergency room will likely be the only place that’s properly equipped to handle certain conditions.
Do Urgent care centers accept insurance?
It is up to the insurance provider whether they cover urgent care centers or not. However, many insurance providers cover urgent care visits, but patients will be expected to pay the co-pay or deductible implied by their plan.
You should also be aware that an urgent care center may choose not to accept your insurance, even if your insurance provider would otherwise pay for the care. This could be avoided by calling the urgent care center ahead of time and asking if they accept your insurance.
Look Up for “Self-pay” Rates
Websites such as Healthcare Bluebook, FairHealth and SolvHealth allow you to get an estimate of how much your urgent care visit is going to cost. The self-pay rate is the charge set by clinics for patients without insurance. It may also be possible to get a payment plan.
Call Before You Go
Calling ahead of time allows you to check for available time slots and leads to a better understanding of how the urgent care center charges patients without insurance. While calling beforehand, you may want to ask about their pricing for patients paying out of pocket.
Ask the Right Questions
When going for your visit, make a list of questions regarding pricing and services for the visit. Here are some examples:
- How much will this test cost?
- If I need an x-ray or additional testing, how much will it cost?
- Is this the only test I need for today?
- How much will this prescription medicine cost?
- Is there an office visit fee?
- What other administrative fees can I expect?
- Are there separate charges for the office visit and in-house lab tests?
- Is there a bundle price for certain services?
Health Insurance Claim Denial Reasons
An Insurance might deny your claim for several reasons:
- A provider or facility isn’t in the health plan’s network.
- A provider or facility didn’t submit the right information to the Insurance.
- A health plan needed more information to pay for the services.
- A health plan didn’t deem a procedure medically necessary.
- A clerical error.
How to appeal health insurance claim denial?
Here are seven steps for winning a health insurance claim appeal:
- Find out why the health insurance claim was denied.
- Read your health insurance policy.
- Learn the deadlines for appealing your health insurance claim denial.
- Make your case.
- Write a concise appeal letter.
- Follow up if you don’t hear back.
Urgent Care Cost without Insurance (Self-Pay) in 2021
it is difficult to know how much an urgent care visit costs without insurance because every facility and company will charge differently depending on the services you’re receiving.
The Average Costs for Different Services at Urgent Care
|Reason for Visit||Price without insurance|
|Urinary Tract Infections||$111|
|Upper Respiratory Infections||$111|
Office Visit Cost
|Urgent Care||Baseline Visit Fee||What the office visit cost includes|
|American Family Care||$140||Physician visit|
|Fast Med||$119 or $199||Provider visit and 2 tests; provider visit and medical procedures|
|CityMD||$200||Provider visit and minor procedures|
|NextCare||$160 or $275||Office visit; additional in-clinic services|
|Patient First||$129||Routine visit|
Average Out of Pocket Urgent Care Costs in Major Cities*
|City||Out of Pocket Cost|
|New York City, NY||$189|
|Los Angeles, CA||$175|
|Salt Lake City, UT||$175|
|Las Vegas, NV||$135|
*These costs reflect the office visit cost, 1 test (ex: rapid flu, strep tests). Additional testing could range between $15-60 per test. An x-ray could cost an additional $65, and higher-level services could add $99 or more.