When individuals experience sudden health problems or suffered a minor injury, they are apprehensive about whether to get an appointment with their primary care provider or visit an urgent care facility.
When Individuals Should Obtain Urgent Care
Individuals under the following health conditions should go for an urgent care facility for the treatment of their conditions:
- Suffering non-life-threatening symptoms of an illness that should be addressed the same day.
- Suffering minor non-life-threatening injuries that require immediate consultation.
- Individuals who are unable to obtain an appointment with their primary care physician but immediately need a prescription, minor injury, or other treatment, possibly the same day.
Urgent care is the best option for individuals who need to address their non-threatening injury or illness on the same day. In case if they need medical care on a weekend or after their primary care provider’s hours of operation, then urgent care is the best option, as they are functional during the weekend and in the evening.
Individuals seeking urgent care facilities can generally walk-in to obtain the service whereas in some cases they will need to make an advance appointment online. The majority of the urgent care facilities have x-ray machines and can perform medical services, which they usually get from a primary care provider or emergency room.
However, urgent care facilities don’t have the equipment and staff to treat life-threatening conditions. Therefore, individuals upon experiencing a life-threatening illness or injury will need to visit the ER and not an urgent care facility. Besides, as per a published article, relying on urgent care facilities is not always beneficial and may sometimes lead to inappropriate treatment. It is considered that some of the urgent care facilities prescribe unnecessary antibiotics compared to other medical facilities. It is believed that antibiotics don’t prove effective in the treatment of viral infection and may cause harm due to the associated side effects, and also due to its over-usage can lead to bacterial resistance.
Is Urgent Care Covered under Health Plans?
Though all ACA-compliant plans are required to cover the ten essential benefits including emergency care, urgent care is not always considered emergency care. However, some of the plan cover for urgent care visits but patients are expected to pay a copay or deductible for their visits to urgent care facilities. Urgent care visits on average may cost patients around $150 that is usually covered but patients are required on average to pay a copay from anywhere from $35 to $100. Urgent care visits are cheaper than ER visits. In some of the cases, an individual’s plan may not cover urgent care or an urgent care facility may not accept an individual’s plan even if their health insurance otherwise covers their visit. Thus, individuals should check their plan details if they are not sure whether their plans cove urgent care visits or not.
Individuals are Recommended to Visit their Primary Care Physician
People are often advised to visit their primary care provider over visiting urgent care because it has been revealed through studies that continuity of care increases patient satisfaction. Albeit, patients might not have access to primary care physicians during nights and weekends but it does offer continuity of care and other services that are not offered by the urgent care.
Primary care physician keeps and update their patient’s medical history and also has access to medical records and health history of patients that ensure them that they get appropriate and consistent care. Primary care physician develops a relationship with patients that help in reaching the set health goals. If required, the primary care provider also coordinates with the specialist to provide the best treatment and also provide preventive care services. All these services are not included in the urgent care.
Do Primary Care Visits Covered under Health Plans?
Individuals should know that their primary care visits are generally covered under their health plan. Since the ACA requires health plans to cover 10 essential health benefits including preventive and wellness services along with chronic disease management. However, individuals enrolled in a short-term plan, or accident insurance are likely to not get covered for primary care visits. Usually, health insurance companies decide on the way to cover these benefits, so people must check the plan details before enrolling in a plan. Usually, a major medical health plan or an ACA-compliant plan provides coverage for doctor visits either with a copay or they will pay the out-of-pocket and the cos will go towards their deductible amount.