Urgent care costs and prices

At times, folks are encouraged NOT to go to the ER for minor emergencies, but instead go to urgent care centers. But what should urgent care costs be?

Nowadays, there are 10,000+ urgent care centers in the US – far more than the number of emergency rooms. So, let’s discuss how you can avoid making financial mistakes by choosing to go to an urgent care clinic when you need medical assistance, a lab test, or a vaccination. 

Healthcare need not cost you so much. Being a smart consumer of healthcare services can be challenging indeed. Here are common mistakes you need to avoid to enjoy reliable yet budget-friendly healthcare.

Mistake #1
Going to a “big chain” urgent care

Go to an urgent care chain with 20 or more locations and, chances are, you’ll have to cough up a pretty penny.

Why? The costs of big chain urgent care centers are often three times that of smaller urgent care centers.

You might think, “I have health insurance, why should it matter at all? My insurance will foot the bill”. Well, you are in for a $300+ sticker shock. You forgot that deductible!

A deductible is a portion you pay for covered healthcare services before your health insurer starts to pay. As of 2019, there are hardly any health insurance plans that have a zero deductible amount.

Here’s a real case scenario from a Big Chain Urgent Care in NYC:

You have Big Blue Insurance.

You have a $5,000 deductible.

You have a $50 co-pay.

This means you’re required to pay the first $5,000 of all covered services before your insurance provider even becomes liable for any costs.

Here’s how this will work:

You visit the Big Chain Urgent Care.

They’ll collect your $50 copay at the time of the visit.

You go home after your visit.

The Big Chain Urgent Care now submits a bill for $350+ to your insurance plan because that’s what their contract with Big Blue Insurance Company states. (The same Big Blue Insurance Company had contracted rates of $100 with other urgent care centers in your neighborhood – you just had no way of knowing that, of course).

Your insurance provider approves all their charges as per their negotiated fee arrangement with Big Chain Urgent Care. The amount of $350+ becomes payable to Big Chain Urgent Care. But your insurance provider knows you have a deductible. So, it applies the $350 amount toward that deductible.

You already paid $50 as a copay when you had your visit. The Big Chain Urgent Care is told that $300 ($350 charge minus the $ 50 copay) is the member’s responsibility as the deductible has not been met. That member is you. And that “big fat bill” from the Big Chain Urgent Care is now coming to you!

Guess what?

You now have to cough up another $300. All because there’s no transparency in health care. It is rigged to benefit Big Chain Urgent Care. It’s geared towards sick care, not health care. That Big Chain Urgent Care will now want you to see the hospital doctors and specialists who are “all-in” on this.

In fact, three of the “Big Chain” Urgent Care Centers in NYC have a negotiated rate of $300+ with many insurance companies and over $200 with others. Had you chosen to go to Nao Medical, your out-of-pocket expense would have barely touched $150 in total. You could’ve paid all of it in person and be done with it.

What can you do to reduce your urgent care cost and fees?

It can be a harrowing experience for sure. The worst thing is not knowing what one’s financial liability will be.  Many customers using these Big Chain Urgent Care Centers are stuck with bills of several hundred dollars.

Followed by calls from their “network doctors” to enroll in their next version of care: Primary care, radiology for imaging, orthopedics, anesthesia, and other medical services where out-of-network specialists can bill preposterous amounts.

They’ll send you to the hospital labs for blood tests or may refuse to do ANY blood tests at their facility because they want you to go somewhere else. The more you circulate within their network, the more opportunities they have to generate billable services. So, what can you do to negotiate a flawed system like this?

• First and foremost, find out your potential financial liability before you go to that Big Chain Urgent Care Center by calling your health plan and asking them about the contracted charges. Remember, Big Chain Urgent Care Centers are now the ‘new’ and ‘overpriced’ emergency rooms of yesterday. And they’re giving all urgent care centers a bad name.

• Secondly, call around the urgent care centers in your area and ask about their pricing. Many staff at these facilities may not be able to answer all your questions as they’ll not know what your potential treatment will be. Their pricing will give you some idea, at least.

• Thirdly, visit their website. Look for price transparency in costs-fees and service charges. 

Mistake #2
Not knowing your co-pay before you go to the urgent care

If you’re young and healthy, chances are you have never had to use your health insurance plan. It’s very common for people to not know what their copay is for an urgent care visit. As a result, you may not have carried with you enough money or have the credit card to charge the copay.

What can you do to find out your copay cost?

Here’s how you can find out your copay information:

1. The copay is usually listed on the health insurance card.  ER copay is often the highest at $100 to $500 or more. Urgent Care copay is usually in the $40-$75 range and the Primary Care Physician copay is usually in the $25-$40 range.
2. Sometimes you will not find an urgent care copay. However, there’ll be a specialist copay listed. Urgent Care copays are usually the same as a specialist copay.
3. You can call your health plan and find out your copay.
4. You can walk into an urgent care facility and our staff can swipe the insurance card and let you know what your benefit plan coverage and copay are before you decide how you want to proceed.

Mistake #3
Going to a hospital-based Urgent Care

Many hospitals have opened their own urgent care or affiliated themselves with one. This is to keep their footprint in the communities where customers live and work. Hospitals call customers with insurance “covered lives” and capturing every covered life in their territory is the basis for their profitability and their negotiating power with insurance plans, Medicare and Medicaid.

Getting insured patients through PCPs is no longer a viable option as 70% of millennials don’t have PCPs and don’t want to be captive lives in a network. So, they have turned to Urgent Care to ensure they keep enrolling covered lives and help maintain a constant flow of labs, tests, radiology imaging, specialist referrals, and procedures to their hospital-affiliated network.

This kind of urgent care visit has the potential to be an expensive option. If you have a cut or an injury, they’re more likely to refer you to an Orthopedic or a hand surgeon rather than do the stitches themselves. They’d rather you go to their other office for getting blood tests done. Or visit their community-based radiology imaging facilities for a CT Scan or an MRI.

What can you do to find out the costs and fees for your visit?

Here are some options:

1. Before you get seen, ask if the facility bills as an urgent care or as an ER. Write down the name of the employee that gives you that information. When you receive an ER bill for that visit, you will be able to go back to the billing office and negotiate better because you’ll have the name of the employee that misinformed you in the first place.

2. Avoid Big Chain Urgent Cares completely and go to urgent care with less than 20 locations. Most likely your bills will be half of what a Big Chain Urgent Care would charge and collect from you. 

Mistake # 4.
Not considering a virtual visit

If you’re in a bind, there are far more economical options than going to a Big Chain Urgent Care.

A typical Urgent Care visit may cost you around $100. A virtual consultation costs far less.

How do you cut your costs and fees for medical services with a virtual visit?

The world of Televisists can be confusing. You want to use a Televisit option with a physical office as a backup, just in case you need blood tests or X-Rays or someone to check you out in person.

There are urgent cares that can provide medical assistance through a virtual visit from the comfort of your home. You do not need anything except your smartphone, iPad, or computer and a decent wifi signal.

If you haven’t tried a Televisit, you must! It can be scheduled between your meetings, during your lunch break, or even late at night when most urgent care centers are closed.  The prescriptions will be sent electronically to a pharmacy near you. Insurance covers these visits and if you’re paying for them yourself, these visits aren’t expensive.