Top 5: Ways to Control the Cost of Healthcare #2

2. Choose the right care facility (Primary Care Physician vs. Urgent Care vs. Emergency Room)

There are lots of options when it comes to where you go to receive health care services, and those options have different purposes as well as different financial implications.

Duke Health offers the following explanation of when to use each type of health care service:

Primary Care Provider

Unless you are experiencing a life-threatening emergency, primary care centers are the best places to start. Primary care providers are physicians who deliver basic care for common illnesses. They are your first stop for most undiagnosed health concerns.

You should visit a primary care center for illnesses such as colds, flu, and sore throats; minor injuries, aches, and pains; or routine health exams. You can schedule appointments with primary care providers during the week, and they are available by phone anytime for advice about health problems.

Urgent Care Center

If your primary care physician is not available and you need quick medical attention for a non-life-threatening problem, visit an urgent care center. Urgent care centers have similar resources to primary care facilities, but they provide comprehensive quality care on a walk-in basis with extended hours.

Go to an urgent care center when you need immediate medical attention or have non-emergency health concerns after hours. Examples include ear infections, sprains, simple cuts and burns, and eye injuries.

Emergency Department

Life-threatening emergencies and late-night trauma require an immediate visit to the hospital. Emergency rooms offer inpatient care, emergency services, trauma services, and more. Emergency clinicians are able to recognize, diagnose, and make recommendations for a wide array of medical issues.

Call 911 or drive to the emergency department at your nearest hospital whenever conditions cause severe symptoms and/or put your health at serious risk. Examples include heart attacks, poisoning, severe bleeding, and broken bones.

While life threatening emergencies require a visit to the emergency room, other illnesses or injuries do not and can offer significantly lower cost options for care.

For instance, let’s say that your benefits are as follows and you have already met your deductible year to date:

Covered Benefits	Network	Non-Network
Deductible (single/family)	$1000/$3000	$2000/$6000
Out of Pocket Limit (single/family)	$4000/$8000	$8000/$16,000
Physician Home and Office Services (PCP/SCP) Primary Care Physician(PCP)/Specialty Care Physician (SCP) Including Office Surgeries and allergy serum: ·         Allergy injections (PCP and SCP) ·         Allergy testing ·         MRAs, MRIs, PETS, C-Scans, Nuclear Cardiology Imaging Studies, non-maternity related Ultrasounds and Pharmaceuticals	$20/$50 $5 20% 20%	40% 40% 40% 40%
Preventive Care Services Services include but are not limited to: Routine Exams, Mammograms, Pelvic Exams, Pap testing, PSA tests, Immunizations (1), Annual diabetic eye exam, Routine Vision and Hearing screenings	$0	40%
Emergency and Urgent Care ·         Emergency Room Services @ Hospital (facility/other covered services) copayment waived if admitted ·         Urgent Care Center Services -       MRAs, MRIs, PETS, C-Scans, Nuclear Cardiology Imaging Studies, Non-Maternity related Ultrasounds and Pharmacueticals -       Allergy injections -       Allergy Testing	$200/20% $75 20% $5 20%	$200/20% 40% 40% 40% 40%

You have been experiencing a sore throat for a day or so. It is beginning to get worse. You decide that you need to see a doctor, but it is 7pm. Your in-network options are:

See your family doctor tomorrow

-       Pros:

o   You can set an appointment as soon as the office opens

o   Your doctor is already familiar with your medical history

o   You may only be responsible for a $20 copay + 20% coinsurance for testing

-       Cons:

o   You will have to wait until the next day to receive care

Go to an urgent care now

-       Pros:

o   You will be able to get in the facility right away

o   You will be able to be see a doctor with minimal wait time

-       Cons:

o   Your physician will not know your medical history

o   You will be responsible for a $75 copay + 20% coinsurance on the charges (which tend to be slightly higher than a primary care physician)

Go to an emergency room now

-       Pros:

o   You will be able to get in the facility right away

-       Cons:

o   You may have significant wait time. Emergency rooms see patients by severity of issue. With a sore throat, you may be very low on the list.

o   You will be responsible for a $200 copay + 20% of the charges (and emergency room charges can be 3-4 times higher than a primary care physician)

Ultimately, you know yourself and the severity of your symptoms. You need to make the right decision for your care based on the level of your need first, but after that, you should consider the pros and cons of each place of service.

For more ways to control your healthcare costs, check out our Top 5: Ways to Control the Cost of Healthcare and check back often for articles explaining further each of these examples.