Urgent Care or ER? How to Decide Where to Go

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A few weeks ago, I was walking with my husband at the park when an enormous, bearlike dog came out of nowhere and barreled into me. Caught by surprise, I got knocked into the dirt. When the shock wore off, I realized my ankle had twisted in a way it wasn't meant to and I had trouble getting to my feet. Within an hour, my ankle had swollen to double its normal size and I couldn't put weight on it.

I was about to head to the emergency room (ER) — and the huge bill that would undoubtedly come with it — when I reviewed my insurance policy to see what my copay would be. In the paperwork, I found out that going to an urgent care facility would be much cheaper. I was thrilled and the urgent care facility I visited helped me get back on my feet (literally).

If you're sick or injured, your first instinct might be to head to the emergency room. However, doing so can come with a large bill. In fact, the average ER bill is a staggering $2,259, according to Cigna. Visiting a local urgent care center, where the average cost is just $176, might make more sense. Here are a few key things to consider before going to the hospital. (See also: How to Handle a Massive Medical Bill)

Seriousness of illness

When deciding where to go, consider just how serious your injury or illness ill. If you're sick or have an infection and your doctor is unavailable, you may think the ER is your best bet. However, some insurance companies don't cover ER visits for non-life-threatening emergencies. That means that if you have something like pink eye and go to the ER, you could end up footing the bill entirely on your own.

If you're not facing a true medical emergency, an urgent care facility is a cheaper and safer option.

Services

Although urgent care facilities are usually cheaper and more convenient than the ER, they have limitations. They tend to have X-ray equipment, EKGs, and lab testing, but lack the facilities needed for more complex illnesses or problems. And, urgent care centers usually just have one or two doctors available and no specialists. Because of these factors, urgent care facilities are best for short-term illnesses or injuries, such as:

  • Coughs.

  • Minor injuries or burns.

  • Fevers.

  • Stomach pain or vomiting.

  • Sore throat.

If you have a more severe injury or illness, an urgent care facility might not be able to give you the care you need. Instead, you may need the tests, expertise, and care that only a hospital can provide. You should head to an emergency room (or have someone take you) in the following situations:

  • Head injuries.

  • Allergic reactions.

  • Unconsciousness.

  • Deep wounds or severe burns.

  • Chest pain.

  • Major broken bones.

Availability

If you are hurt or sick outside of your doctor's normal business hours, both urgent care centers and the ER are useful options.

Although urgent care facilities tend to have longer hours than your normal doctor, they are not usually available around the clock. If you are injured late at night or very early in the morning, your only option may be the ER.

Wait times

Most urgent care centers operate on a first-come, first-serve basis. You could wait as little as five minutes to see a doctor or have X-rays done. You'll also get necessary treatments and be on your way home faster than you would seeking treatment at a hospital.

Emergency rooms work differently. They use a triage system, where patients are seen based on the seriousness of their condition. If you have a mild problem, such as a sprained ankle or a sore throat, you could wait several hours so that others can be seen first.

In-network vs. out-of-network

Many doctors working in emergency rooms are independent contractors. That's important to know, because that means they may not operate within your insurance provider's network. Visiting the ER and being cared for by an out-of-network physician can mean a huge bill later on.

If possible, going to an in-network urgent care center will be cheaper than going to the ER. However, if your illness or injury is serious and you need to go to the ER, you can request an in-network doctor when you fill out your admissions forms.

Payment plans

Depending on your condition and whether or not you have insurance coverage, you could be on the hook for a large medical bill regardless of what kind of center you visit. If you are short on cash, where you go can affect what payment options are available to you.

Most urgent care facilities require payment in full before you leave and don't offer payment plans. If you don't have insurance, you could have to pay hundreds or even thousands right away. Without that money in savings, you might have to rely on credit cards to pay it and end up in debt.

Emergency rooms often have more leeway. They may offer payment plans or even have charitable funds set aside to cover the costs of low-income patients. Talking to the billing department about your situation can help you identify all of your options so you can pay for necessary treatments. (See also: What to Do If You're Hit With a Huge Medical Bill)

Managing your medical bills

If you've already been hit with a big bill after medical treatment, don't panic. There are ways you can negotiate your medical bills and qualify for financial assistance or reduce how much you owe.

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