Consumer IQ

When To Go To The ER: A Financial Perspective

It’s the middle of the night, and your child has a fever. Or maybe your spouse is having some mystery pain that has you worried. How do you get the care you need—while avoiding that ominous emergency room cost?

The best plan is to know what options are available to you before you need them. Your health plan may have services specifically designed to help you in these situations. And in the long run, by avoiding unnecessary hospital costs, you’ll be doing your part to keep your insurance premiums lower.  Here are some places to start:

Nurse Advice Lines: Many health plans provide free 24-hour nurse advice lines to their members. A nurse may be able to advise you on whether it’s appropriate to wait until morning to see the doctor – or if you should head to the ER right away. Check to see if your plan offers this benefit and if they do, keep the number handy—in fact, just save it in your phone right now so you don’t have to look for it again.

Community Primary Care Clinics: Find out which clinics are located in your area and how they work with your health plan. If you have a PPO, some doctors there may be covered by your plan. If you have an HMO, you can ask about sliding scale rates, but most of the time, if you have some form of insurance, you will not be eligible for sliding scale. And since your care will not be covered without your primary care physician’s referral, this option could become pretty expensive.

Urgent Care Clinics: Some hospitals operate urgent care clinics that have extended hours. They may be part of a public health system or associated with a private hospital. Fee scales can vary for these clinics depending on your insurance (and be completely different from that of the primary care clinic).

Retail or Minute Clinics: These privately run clinics can provide quick, walk-in health services for a low flat fee (fee for service). Many minute clinics have evening and weekend hours. However, they are not equipped to handle emergencies, serious injuries, or complex issues. What can they do? Think basic sprains and strains, cuts, strep throat, pink eye, or poison ivy. For anything more severe, these clinics won’t be able to help.

Plan ahead with your primary care physician: If you are especially concerned about being in the midnight-ER-visit situation, consider choosing a doctor that prioritizes patient access. Ask their office:

- If they have expanded evening or weekend hours

- If they provide same-day appointments

- How long it usually takes to get an appointment

- If physicians are available via email

Most of the time, your primary care physician is your best bet for getting low cost, reliable care, so start with them (the exception can be if you have a PPO and an established relationship with a specialist).

And as a last resort, you do have the emergency room. But keep in mind that ERs are not designed to provide routine health care. So while you might get your health issue addressed, it most likely will not be in a timely or cost efficient manner. Emergency rooms are supplied with physicians and equipment to handle severe trauma, so when you go there with a minor health issue, you are still paying (and waiting) for this specialization.  Plan ahead and know your options, and you might find a way to take care of your problem without emptying your pockets.

Note: I am not qualified to give medical advice. If you ever feel your health is in danger, getting appropriate medical treatment should come before financial considerations.

Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitterfacebook or email.