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How Much Does Urgent Care Cost: With and Without Insurance?

Sidecar Health

October 19, 2021

First things first: what is “urgent care”? Say, you have a sudden health condition that’s concerning to you but doesn’t necessarily rise to the level of a true emergency in your opinion, like a troubling rash or gnarly bug bite. You call your primary doctor, and they are booked for three weeks solid. Enter urgent care. 

Urgent care may be warranted when you feel you’re in a situation that isn’t necessarily an emergency but you would like to see a medical provider before you’d be able to make it in to see your primary doctor. The types of services generally provided by urgent care include providing treatment and prescribing medication for fevers, allergic reactions, ear infections, urinary tract infections, sprains and strains. 

Now that we’ve established a few of the use cases for urgent care, the question of cost remains. So, how much is urgent care with or without insurance?

It’s best to explore the differences and generalized costs to determine the right option in the event that you need care, so that you can make a good choice for yourself when it is necessary. Because of that, we’re glad you’re here! Comparing the cost of urgent care visits with emergency care, as well as what it costs for an appointment with your primary care provider will help you decide when to schedule a visit for each in relation to your situation. That said, you should never compromise your healthcare needs based on the financial implications for treatment alone. Your health should always be the number one priority. 

Cost of Urgent Care Visits and Treatment

Urgent care centers are considered a half-way measure between a primary care physician and a visit to the emergency room for services. They are convenient because they primarily take walk-in appointments and offer services during extended times beyond that of the typical doctor’s office. 

If you are covered by a traditional health insurance plan, urgent care may be covered in full. This depends on the details of your individual plan: if you have a deductible and the deductible has been met, if you have coinsurance, if the urgent care center you visit is in-network or out-of-network, and so forth. 

If you don’t have insurance, it’s another story of course. An urgent care visit is often a fraction of what an emergency room visit would cost. However, most patients are looking at a minimum of $100 to $150 for a walk-in urgent care visit depending on their copay–even at relatively affordable clinics. On top of this, there may be additional costs for lab work, X-rays or prescriptions needed, depending on the situation.

The quality of the care you may receive is also something to consider. Urgent care facilities are generally staffed by family care physicians who can provide the same types of services as offered in a general practitioner’s office. Keep in mind, they do not keep medical histories as your primary care provider does. Although they perform a similar intake during your visit regarding symptoms, allergies, and previous ailments or medical history, they do not keep this on file for every time you return. 

Additionally, urgent care facilities are not equipped with the same sophisticated equipment and technology as a primary care provider or emergency room necessary to handle critical conditions. Many urgent care centers have X-ray machines and perform lab testing. However, certain urgent care clinics may not have this availability. If this is relevant to your situation, you may want to call ahead of time to determine if they have the machinery or services that you think you may require.

Walk-in clinics are also largely staffed by nurse practitioners versus family medicine doctors and can be found in most local pharmacies or grocery stores, making it more convenient to find a location where you can be seen right away.

Cost of Emergency Care and Treatment

Emergency care and medical treatment costs are much higher and more advanced due to the nature of the condition and the convenience of care. Although urgent care service facilities and walk-in clinics often offer extended evening hours and weekend times, emergency rooms are open 24 hours a day, 365 days of the year. Seeking emergency room treatment should be limited to life-threatening injuries or symptoms only. These may include but aren’t limited to: 

  • Trouble breathing
  • Severe abdominal or chest pain
  • Internal bleeding
  • Spiked fevers, especially among children
  • Poisoning
  • Severe head or eye injuries

Emergency room visits may also be covered under most health insurance plans, though there is a co-pay, which is higher than the cost of an urgent care visit. As an example, visiting the ER for a respiratory infection costs approximately $100 for an urgent care visit, while it could cost over $1,000 for treatment at the emergency room. 

Furthermore, you’ll want to consider the cost of an ambulance ride, if applicable, which may be separate from the visit itself. The cost of an ambulance ride can range from $25 to $1,200 depending on if the individual has insurance coverage. Similar to urgent care, you can be admitted to the ER without insurance, although you will be responsible for full payment for care upon being discharged. 

Regardless of whether you have health insurance coverage or not, it’s important to evaluate whether or not the treatment you need is truly an emergency. The decision may vary depending on the person and the condition. If you’re unsure about whether or not to make a visit to the ER, consider the severity of the pain, condition, or injury and whether the cost is worth it.

Primary Care Provider Cost and Treatment

What is a PCP (primary care physician)? A primary care physician is generally your main point of contact in terms of healthcare. They help you with preventive care and ongoing treatment. Although they may handle emergency situations, at times, they are likely not fully equipped or fully staffed to handle life-threatening situations. They may have a preferred urgent care or ER to recommend when those types of situations arise. However, to meet the standard of care required for an emergency situation is not what a primary care doctor is trained for.

The cost of a PCP visit depends on the level of your health insurance plan, the reason and frequency of visits, type of provider network, as well as the particulars of your health insurance plan, like your deductible and copay.

Some PCPs offer primary care plans, which often allow members to pay a flat or discounted cost to be seen by their primary physician. This is not a form of insurance, to be clear, but may help to curb costs over time if you seek care regularly.

If your symptoms aren’t too severe or life-threatening but you don’t have a designated PCP at the time when you need assistance, you may be better off seeking medical care at an urgent care clinic. For one, it can take some time to find the right PCP for you and once you do, it could be a bit of a wait before they have availability to see you. 

If you do have a PCP, your best bet is to give their office and call and ask for a recommendation. After all, the call is free.

Negotiating Medical Bills

Did you know you can actually negotiate your medical bills? In fact, with just a little effort, you can actually cut your bill quite a bit. When it comes to reducing the price of your medical bill, make sure you study all costs and do your research. Procedures, services, supplies, and transportation can all influence the overall price. Make sure you review all charges to make sure they are accurate before making a payment. 

Once you have all the facts, pick up the phone and call your health insurance provider. While speaking to a representative, learn about your different options and ask plenty of questions. In some cases, you may be able to ask for medical forgiveness. Regardless of your situation, the best thing you can do is talk to your provider and learn about the different options available to you.


Sources:

https://www.debt.org/medical/emergency-room-urgent-care-costs/

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