When to Go to Urgent Care vs. The Emergency Room

While your primary care doctor should be your first choice in non-emergency medical situations, they may not always be an option. Illnesses and injuries often occur unexpectedly in the middle of the night or on the weekends when your doctor’s office may not be open. Should you go to an urgent care facility or an emergency room (ER) to seek medical care for you or a loved one? Both options provide urgent medical attention, but several factors can help you determine which is right for your situation.

Knowing where to go based on how immediately you need treatment and what’s covered by your insurance is almost as critical as receiving medical care. Below, Custom Health Plans analyzes the differences between urgent care vs. emergency rooms for patients in the Dallas-Fort Worth metroplex and surrounding communities across Texas, including Plano, Austin, San Antonio, and Houston.

What Is an Urgent Care Facility? What Do They Do?

Urgent care facilities provide medical treatment for conditions needing prompt attention but aren’t usually life-threatening. Most urgent care facilities are open with extended hours, including evenings and weekends, making them a convenient option for those needing medical care outside their primary care physician’s standard hours. While some have physicians on staff, urgent care facilities are typically staffed with nurses, nurse practitioners, and physician assistants who can provide urgent care for various conditions that don’t require specialists.

Urgent cares often have on-site diagnostic equipment, including X-rays and basic lab testing, allowing for quick medical diagnosis and treatment. If your illness or injury is something you’d feel comfortable discussing with your primary care doctor during standard business hours, it can likely be addressed at your nearest urgent care. You would likely visit an urgent care facility for illnesses or injuries requiring care within 24 hours, but those that may not warrant a trip to a hospital emergency room. Conditions commonly treated at an urgent care facility include:

• Minor cuts and wounds
• Sprains and strains
• Fever or flu-like symptoms
• Allergic reactions
• Ear infections
• Sore or strep throat
• Animal or insect bites
• Seasonal allergies
• Moderate asthma issues
• Urinary tract infections

What Is an Emergency Room (ER)? What Does an ER Do?

A hospital emergency room, also known as an ER, provides immediate medical care for many life-threatening conditions. Emergency rooms are open 24 hours a day, 7 days a week, and are equipped with advanced medical technology and trained physicians, specialists, and staff to handle critical situations, ranging from heart attacks and strokes to traumatic injuries caused by car accidents.

Wait times tend to run longer in most emergency rooms compared to urgent care facilities. However, severe injuries or illnesses that could potentially result in death without prompt intervention and care require an emergency room visit. If you’re unable to drive yourself or a loved one to the nearest ER for treatment due to the severity of the illness or injury, calling 911 ensures help is immediately on the way. Common conditions treated in a hospital emergency room include:

• Heart attack symptoms (chest or abdominal pain, difficulty breathing, lightheadedness, etc.)
• Stroke symptoms (weakness, numbness, paralysis, confusion, slurred speech, etc.)
• Severe head and eye injuries, including concussions
• Major trauma or injuries
• Severe burns or cuts requiring stitches
• Facial lacerations
• Seizures
• Broken bones or dislocated joints
• Severe allergic reactions
• Poisoning
• Vaginal bleeding with pregnancy
• Severe cold or flu symptoms (especially with high fevers or rashes among children)

Comparing Cost Differences Between Urgent Care vs. ER

While convenience, medical vulnerability, and the severity of the situation play a significant role in making healthcare decisions, cost is also an essential factor to consider. The co-pay for a visit to your primary care doctor’s office will likely be less than a trip to an urgent care facility or emergency room, but how do you decide between the other two when your doctor isn’t an option? Generally, urgent care facilities have lower treatment and facility fees compared to emergency rooms, making them the more affordable choice in many circumstances. This is because they don’t provide specialized or critical care.

Depending on your insurance carrier and health insurance plan, it may be worth researching if the nearest urgent cares and emergency rooms are considered in-network vs. out-of-network, as this can also impact your billing. Generally, in-network physicians and healthcare facilities are more affordable than those outside your insurance network. If you have a customized health insurance plan through Custom Health Plans of Texas, we have many client resources available to help you understand your plan and network coverage. Your provider or primary care physician’s office may have a hotline you can call to help you make a better-informed decision on the appropriate medical care to seek.

Does Insurance Cover the Costs of Urgent Care & ERs?

Insurance is accepted at urgent care facilities and emergency rooms, but coverage and co-pays may vary depending on your specific plan. It’s always a good idea to check with your health insurance provider to understand your coverage for urgent care and emergency room visits. While the law requires hospitals and hospital-owned facilities to provide medical care for every patient regardless of their ability to pay, some privately owned urgent cares aren’t required to provide treatment for uninsured patients. Urgent care and emergency room visits can be costly. Even if they’re usually considered the more affordable choice, urgent care visit costs without insurance often include medical imaging or lab testing fees, which can add up and significantly increase your out-of-pocket costs.

Does Urgent Care Bill You Later Without Insurance?

Urgent care facilities not owned by hospitals may require payment at the time of service for patients without health insurance. However, depending on your circumstances, you may be able to negotiate a low-interest payment plan or an income-based discount. Some may consider looking into short-term health insurance coverage to help with urgent care costs for a specified period. Regardless of whether you have health insurance, the failure to pay your urgent care or emergency room visit costs may result in collection agency activity that could negatively affect your credit score.

When to Choose Urgent Care vs. an Emergency Room

Knowing when to go to an urgent care facility vs. an emergency room in the DFW metroplex area or elsewhere in Texas can save you time, money, and potentially even your life. Urgent care is an excellent cost-saving option for non-life-threatening emergencies needing prompt attention, especially when your primary care doctor’s office is closed. However, seek treatment at your nearest emergency room if you’re experiencing a severe or life-threatening medical issue. It’s best to err on the side of caution when it comes to your health. If you’re unsure about the severity of your condition, trust your instincts and seek emergency room care. After all, your health should always be your top priority, not the billing.

Contact Custom Health Plans for Comprehensive Coverage

Custom Health Plans brings a wealth of knowledge to assist Texas residents seeking the best health insurance coverage at competitive prices. We have established relationships with many leading health insurance carriers, including Aetna, Cigna, BlueCross BlueShield Association, and Humana. We work with individuals and families across the DFW metroplex, Austin, San Antonio, Plano, Houston, and surrounding communities to tailor health insurance plans to your specific needs.

Premiums are typically lower than traditional plans and provide comprehensive coverage options with the freedom to choose “Any Doctor, Any Hospital.” Obtain peace of mind and feel empowered about your healthcare options by contacting us to schedule a free quote with one of our friendly agents. You’ll receive the highest level of customer service with our customized insurance plans and expertise. Check out our reviews to learn more about how we can help you navigate your health coverage today!