Knowing where to go for care can save time, money

When to go to urgent care vs. ER vs. family doctor

You twisted your back and the pain is growing worse. Should you call your family doctor, head to an urgent care, or drive straight to a hospital emergency room?

Knowing which one to choose – and when – can save you time and money.

What is a Primary Care Provider and when should you see one?

A primary care provider (PCP) is a doctor, nurse practitioner, or physician assistant who gets to know you through regular appointments. You typically see your PCP, commonly referred to as a family doctor, for nonemergency medical issues such as:

• Yearly exams
• Preventive screenings
• Stress management
• Medication management
• Minor illnesses and injuries

PCPs also can help coordinate care for chronic conditions such as diabetes or a heart condition and refer you to a specialist when needed. Generally, copays are lower for PCP visits than they are for urgent care or emergency room visits.

But when an unexpected illness or injury takes place, you may not be able to see your PCP right away. Or you might not have a PCP (if that’s the case and you’re a Capital Blue Cross member, try MyCare Finder).

When to choose urgent care over the emergency room

Urgent care is the middle ground between your PCP and the emergency room (ER). If you have an illness or injury that needs immediate attention and can't schedule an appointment with your family doctor, urgent care might be your best option.

Urgent care centers can help with immediate concerns such as:

• Minor bone fractures
• Back, joint, or muscle pain
• Bronquitis
• Cuts and minor burns
• Diarrhea or vomiting
• Skin conditions
• Infections
• Reacciones alérgicas
• Dolor abdominal
• Fevers

Generally, copayments at an urgent care are more than a PCP visit, but less than an emergency room copay.

When might an ER visit be needed?

According to the Mayo Clinic, ER visits are typically for more serious medical issues such as:

• Chest pain or pressure
• Compound fractures (bone that protrudes through the skin)
• Head injuries
• Neumonía
• Convulsiones
• Severe abdominal pain
• Shortness of breath
• Sudden, severe headache, or paralysis or weakness
• Uncontrolled bleeding

If your emergency is life-threatening, such as choking, a heart attack, or sudden events that prevent you from getting to a hospital but require immediate attention, call 9-1-1.

ERs tend to see the sickest patients first, regardless of when they arrive, so you might wait longer if your condition is less urgent. The median wait time at an ER is 90 minutes.

An ER visit also typically costs more. According to claims data from Capital Blue Cross, the average estimated cost for an urgent care visit is about $137 compared to nearly $2,300 for an emergency department visit.

If you are admitted to the hospital, an ER copay is waived.

Consider telehealth for convenience and cost

Some providers and insurance carriers have telehealth options, which means you can see a doctor using your phone, tablet, or PC. Many can refill and prescribe medications and help determine if you may need to go to an urgent care center or emergency room.

If you’re a Capital Blue Cross member and your plan covers it, our VirtualCare service can help you see a doctor or nurse right away – seven days a week, 24 hours a day. Refer to your Benefits Booklet after logging in to your secure account to make sure your plan covers VirtualCare.