Does Health Insurance Cover Urgent Care?
Many health insurance plans cover urgent care, but you should always check with your specific plan provider to make sure that your benefits cover it. You should also pay attention to the details of your plan, as plans can vary greatly and, even though urgent care may be covered, you still may have a lot of out-of-pocket expenses.
HealthCare.gov defines urgent care as care for a condition, injury, or illness that is serious enough to seek care at once, but not so serious that an emergency room visit is required. It is definitely cheaper than care in an emergency room, but the cost of the care can still be pricey.
Why should you choose to visit urgent care?
When you have certain symptoms or a condition about which you are concerned, you have a few options for getting care. You can wait to make an appointment with your regular doctor (which could take a few days or even weeks), you can make an expensive trip to the emergency room, or you can visit an urgent care clinic.
Urgent care is often chosen by those whose condition is not life-threatening but should be taken care of within 24 to 48 hours. The clinics are usually open when regular clinics are not, such as on weekends and evenings, which makes it convenient for many people.
The standard of care in urgent care is just as high as if you were to visit your regular doctor. The degree credentials for physicians in urgent care clinics are the same as for primary care physicians. A provider for urgent care can also obtain additional licensing through the American Board of Urgent Care Medicine, which refines their urgent care skills.
Visiting urgent care can also cut down on wait time, whether it is in a crowded emergency room or your physician’s office. An urgent care facility has another benefit over your physician’s office. Most primary physicians have to refer you out to a separate facility for diagnostic testing such as x-rays, but urgent care facilities usually have this type of equipment so that they can quickly diagnose things such as fractures.
What will your health insurance cover for urgent care?
There are many reasons why people visit an urgent care facility, so there is no guarantee that everything you go in for will be covered by insurance. The best thing you can do, especially since it is not an emergency situation, is look over your benefits plan; or even better, call and speak with one of your insurance company’s representatives.
Some companies may have different coverage based on whether you visit a facility that is in-network or out. If yours does, you will pay more out of your own pocket if you go to a clinic that is out-of-network and less for an in-network facility.
Some benefits will cover a certain dollar or percentage amount of the total visit, while others will cover each procedure separately. Most insurance companies will have you pay separate co-pays for the office visit, any lab tests or diagnostic tests performed, and for any medication you may need. This money is usually asked for at the time of visit so be prepared with payment of some kind.
If you tend to visit urgent care clinics frequently, check to see if your insurance company has a limit as to the number of visits you have covered every year. You also may have a pre-existing condition clause, which means that if you are visiting the clinic to address on on-going health problem, it may not be covered by your insurance.
What if you don’t have urgent care insurance coverage?
According to the Centers for Disease Control, 18.2% of Americans under the age of 65 do not have health insurance. If you are one of these people or if you find that you do not have insurance coverage for urgent care, don’t panic. You can still get the care you need.
One of the benefits of urgent care is that it is cheaper than visiting an emergency room. Because of the high costs, most patients entering the ER don’t get out of there with a bill that’s lower than $500, and that’s for basic services. The procedures and tests that are performed in an urgent care clinic cost much less.
Some clinics will charge you a flat fee that is due at the time of your visit. They then send out a bill for the remainder of the expenses due. Many clinics will also work out a payment plan so that you can pay the bill off over time.
You can also try offering to pay cash at the time of your visit. Many clinics will charge you less for the visit and the procedures if you are willing to pay cash right away.
You can also check to see if there are any federally funded programs that either offer free or discounted urgent care visits or programs that will help you pay for your medical expenses. Your lack of ability to pay should not affect whether or not you get treatment.