Don’t Pay More than You Need for Unscheduled Healthcare

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Don’t Pay More than You Need for Unscheduled Healthcare

When you least expect it, you or a family member will likely need unscheduled healthcare. Your regular doctor’s office might be booked solid or closed for the night or weekend.

Should you go to an Urgent Care facility or Emergency Room? Does the facility accept your insurance plan and is it in network with your insurance plan? ‘Accepting’ your health insurance is very different than being ‘in network’ with your insurance carrier.  Knowing this difference can potentially save you a great deal of money.

The answers to the above questions will help determine the cost of your care — the amount your insurance pays and any amount you pay out-of-pocket.

Go to an Urgent Care or Emergency Room?

Should you go to an Emergency Room or Urgent Care facility? It depends. Most unscheduled visits can be handled by Urgent Care. Typically, an Urgent Care facility can treat adults and children with minor injuries and illnesses such as colds, flu, asthma, rashes, infections, sprains, and lacerations. Emergency room services are typically equipped for major medical and trauma services such as broken bones, chest pain, strokes, abdominal pain, etc.

When your symptoms are not life threatening, you might want to consider starting at an in-network Urgent Care before stopping at an Emergency Room. If your symptoms are more serious, the health professional at the Urgent Care can direct you to an Emergency Room or call 911.

Remember, if your injury or illness is minor and can be treated by Urgent Care, the cost will likely be considerably lower. Urgent Care prices can be up to 90% less than Emergency Rooms.

Is the Urgent Care in network with insurance?

To find out if a particular provider (Emergency Room or Urgent Care) is in network, search your insurance plan’s lists of in-network (preferred) providers or contact your insurance plan carrier.

Health insurance plans pay a larger percentage of your covered health expenses when you use providers in its network. This means you’ll have lower out-of-pocket costs if you see a provider in the plan’s network. Also, your costs for in-network services are predictable since the provider and your health plan carrier have negotiated the charges in advance. Family Urgent Care PLUS is in network with most major plans and provides clinical services (the PLUS) rarely associated with an Urgent Care. These services include full radiology (CT scans and digital x-rays) and lab onsite for quicker results.

“Quality of care and cost of care are important considerations to our patients and their families,” said Dr. Marco Coppola, Chief Medical Officer. “Our Family Urgent Care PLUS in Frisco is staffed with highly-trained medical professionals and is also in network* with most major insurance plans. Our focus is always on providing the best possible care, with little to no wait time, and at reasonable prices.”

What is the coverage for in-network and out-of-network providers?

It depends on your insurance policy. There are different types of plans such as an HMO, EPO, PPO, and POS. Each plan type can have different rules for providers covered, not covered, and partially covered. Call the Urgent Care center, review your insurance plan, or contact your insurance carrier for details.

What to know before you go?

Before the need for healthcare arises, know what you (or the affected family member) have for healthcare insurance. Find out which Urgent Care providers not only accept your insurance, but are also covered as in network in your plan. Also, look into how your plan may or may not pay for out-of-network provider services.  When you have a choice of multiple Urgent Care facilities in your area that are in network, also consider their hours, wait-time, and the services they offer.

The time to research these considerations is minimal. And the best time to do it is now, before you’re rushing to urgently needed care.

* Operated by CommunityMed Urgent Care

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