When to visit for urgent treatment
Urgent Care Vs. Emergency Room: What's the Difference? - First aid - 2021
If a patient experiences chest pain, they are likely unsure where to go: call 911, call the emergency room, go to an emergency room, or make an appointment with a family doctor.
It is not an easy decision and it is not easy to explain.
Urgency or Emergency?
Some conditions are considered absolute emergencies: heart attacks, strokes, sepsis, anaphylaxis, and gunshot wounds are just some of the diseases that are commonly considered emergencies. They must be evaluated and treated in the emergency room. If a patient goes to an emergency hospital with a real medical emergency, urgent nurses should send them to the emergency room anyway, often by ambulance and often at high cost.
This is only a small part of the emergency. The list is much longer and always includes a diagnosis. In other words, you almost have to know you have a heart attack for it to be a real emergency.
Isn't it the job of the emergency department to let patients know if the symptoms they're experiencing are signs of an emergency? I would say that's true and the American College of Emergency Physicians will agree, but not all health insurance companies. More on that below.
Urgent care centers
When should patients go to the emergency room? It is not an easy question to answer.
One might hear the term "emergency center" and assume that "urgency" is a place where serious medical conditions can be treated in similar, if not identical, ways to an emergency room. The truth is: every state is different. In some states, emergency centers are nothing more than glorified medical offices. Other states treat them as standalone emergency services (a third option we'll cover below), regardless of whether or not standalone emergency centers are an option in that state.
Urgent care centers may be staffed with doctors, or they may be staffed with nurses or resident doctors, depending on the state. Since the individual state legislators respond to the needs of their population, the rules change quickly.
With such irregular regulation, going to an urgent care center is a gamble unless the patient is very clear beforehand what a particular urgent care center can handle. In most cases, people should treat the emergency center the same way they would the doctor's office. It just has more flexible hours.
Would you visit the doctor for a sore throat? Sure, and that's a sensible option for an urgent care center. A spider bite or a skin infection? Also perfect for urgent care documents.
Who pays for the tab?
The whole concept of emergency centers was born out of the uncontrollable cost of health care. People go to the emergency room regularly when they could have gone to their private doctor for much less. Compare the bills for an emergency room and an emergency center side by side and you will find that emergency centers are almost always much cheaper if the condition can be treated.
That doesn't mean it is always cheaper to patiently go to an urgent care center. Even if the possibility of a serious medical emergency that requires an ambulance to be transported from the emergency room to the emergency room is eliminated, the cost comparison is not really apples for apples.
Insurance companies (aka payers) usually contract with facilities and doctors (and sometimes ambulance companies) to get the best rates. There are networks of facilities and doctors who may be cheaper options for payers. The patient's share of the bill (co-payments, deductibles or co-insurance) depends heavily on the insurance company, the coverage plan, and whether the facility or doctor is on the network or not. This is one of the most complicated financial processes that many consumers face.
If urgent treatment is not on the network but in the emergency room, it may cost the patient Less to visit the more expensive option.
Let's sum it up: if both the emergency room and the emergency response center are on the network (or not), the payer nights don't want to pay for the emergency room unless it is an emergency. Payers often find it unnecessary to pay an emergency doctor to examine and diagnose a complaint unless the complaint is found to be truly worthy of the emergency room.
How do patients know if their state of health is a worthy emergency? Based on the doctor's diagnosis, the payer decides whether the patient's judgment is correct. They only know that when they get there.
Some emergency departments have built-in urgency areas and the patient can easily be moved from one area to another depending on their health. These are my favorites. The patient (or insurance) will be charged according to the route required by the patient. Patients who receive a lower deductible to visit the emergency department only when the diagnosis is a real emergency will not receive additional costs if they are wrong. You will only be billed for the more expensive emergency bill if it is reasonable and the insurance company picks up a larger portion of the tab.
In many cases, hospitalization is used by payer as a litmus test to determine whether the patient was really ill enough to go to the emergency room. When the patient is admitted to hospital, the payer can reduce or add to any co-payments or deductibles they renounce. On the other hand, if the patient is not admitted, they will be on the hook for the entire deductible or co-pay. It's the benefit of hindsight and only helps insurers.
Payers hold out the staggering deductible to choose the emergency department as the first medical care. However, most patients have no choice. Doctor visits may not be available on the same day. Patients don't plan on getting sick, and ER are usually open 24 hours a day. Urgent care centers should fill this gap. It's a doctor's office where appointments and inspections are done at the last minute. Unfortunately, not all things that look like clinics are created equal.
Detached emergency rooms
A freestanding or single ER is a relatively new invention that is popping up across the country. A 2017 NBC News Story reported that 35 states allowed stand-alone emergency centers. These are not emergency departments necessarily because they are not always associated with actual hospitals. In many states, these emergency centers are allowed to be owned by doctors.
Stand-alone emergency call centers could be very similar to an emergency unit. They often open in the same places: shopping malls and shopping districts. You're not near a hospital - at least not in the same building - and may have an ambulance entrance.
Most of these facilities offer a wide range of services, but the reality is that any patient in need of hospitalization will likely need to be taken there by ambulance service. Present yourself with a stroke or a heart attack and real definitive treatment may have to wait for the ambulance to respond and be transported to the actual emergency department.
The bottom line
The emergency room, also known as the emergency department, is the ultimate health care option. This is the place where patients can advocate for any stage of the disease, regardless of how severe or benign it is. Emergency departments are also the most expensive option.
A bill for an ER visit will almost always be north of a wing. A trip to the emergency room or doctor's office, on the other hand, is likely to be two or three hundred dollars. It is important to understand the differences and educate patients about the difference so that they can make a better decision.
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