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Key Points
- Each insurance provider determines if it covers urgent care centers or not. However, in most cases insurance providers will cover urgent care, but patients will be expected to pay a co-payment and/or co-insurance.
- For routine, in-network care the average urgent care patient will be charged $20-60 of co-payment, regardless of additional services.
- Urgent care is always more affordable than ER visits, which an NIH study in Texas showed costs over $2,000 per visit, while urgent care was only around $165 per visit.
You’ve got an immediate medical need, but you don’t quite need to go to the emergency room. Where can you go?
Urgent care clinics are a great way to bridge the gap between the emergency room and a prescheduled doctor’s appointment.
Before you decide to get medical treatment at an urgent care center, you might wonder if your insurance will cover the visit. The good news is that you can. You might need to plan a bit because different clinics take different coverage.
Here is a guide to understanding when your insurance will cover urgent care.
When are you covered?
According to the Affordable Care Act (ACA), emergency care is one of the required essential health benefits for all long-term health insurance. However, not all insurers see urgent care visits as emergency care.
Each insurance provider determines if it covers urgent care centers or not. However, in most cases insurance providers will cover urgent care, but patients will be expected to pay a co-payment or co-insurance. In some rare cases, an urgent care center may choose not to accept your insurance, even if your insurance provider would otherwise pay for the care.
While you could safely assume that an urgent care center will take your insurance, it is always best to call ahead and be certain. Because insurance providers have specific provider networks, you might find that some urgent care centers are within the network and others are not. Going to a clinic that’s within the insurance plan’s network is a vital way to ensure you get the coverage you need.
How much does urgent care it cost?
Even with health insurance, you’ll pay a little bit of your own money when you need medical care. You might have an annual deductible to take care of, for example, before your insurance will apply.
For routine, in-network care the average urgent care patient will be charged $20-60 of co-payment, regardless of additional services. Most insurance plans don’t cover non-emergency care outside the network. However, if they do, for routine, out-of-network care the average person might be charged a co-payment of $50-100, depending upon the facility.
If you are left owing additional money, your insurance provider or the clinic will bill you after processing your bill.
Uninsured patients can expect to pay the base fee of $71-125 for an office visit in addition to any extra services rendered (such as medications, IVs, x-rays, or shots). The average total is between $150 - $200 but can vary depending on the urgent care center.
Unfortunately, uninsured patients may have to pay for their visit in full before leaving the urgent care center. Some urgent care centers do offer payment plans, however.
Don’t have insurance, or wonder what you’d pay if you just used your own money? One great way to find out the price of specific procedures is to use Solv ClearPrice™ to avoid surprise medical bills. When you know what to expect upfront, you can take control of both your healthcare and your budget.
Is urgent care cheaper than an ER?
Urgent care is always more affordable than ER visits, which an NIH study in Texas showed costs over $2,000 per visit, while urgent care was only around $165 per visit.
When you need urgent medical treatment but do not feel that a trip to the emergency room is required, urgent care is often the best choice. Urgent care is more affordable than a trip to the ER, and the clinics are also available immediately for whatever your health needs are. This makes urgent care facilities a vital bridge for consumers.
However, it is still a good idea to check with your insurance provider and a specific urgent care location for more information. If you have insurance, it can be a great help, although you’ll still pay some out-of-pocket. Without insurance, you can use Solv to access pricing or book hassle-free healthcare. We’re here to make getting the care you need easier.
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