Where to Go for Acute Care

An acute condition is one that starts suddenly and is over pretty quickly. It can be minor, such as the common cold or a mild sunburn, or serious, such as a broken bone or a heart attack. Knowing where to go for different acute conditions can help you get the best care quickly, at the lowest cost.

Emergency Rooms

Not every acute condition is an emergency. Health insurers usually define an emergency as a situation where your acute symptoms are so severe that, without immediate care, your health or life could be in serious danger. A heart attack or stroke, for example, is an emergency. If you’re having an emergency, call 911 or go to your nearest emergency room (ER).

If you go to the ER without a real emergency, your insurer may not cover the visit. But, what if you’re not sure your acute symptoms are serious enough for the ER? If you think there’s time, call your regular doctor and ask. But, if you feel strongly that you need care right away, it may be prudent to go to the ER.

Going to the ER in a hospital that’s in your health plan’s network will usually cost you less than going out of network. But, many health plans cover part of the costs of emergency care even if you have to go to an out-of-network hospital. In some states, the law protects you on that issue.

To handle emergency cases, ERs are open 24 hours a day, seven days a week. It’s expensive for hospitals to support all that equipment and staff. So, visits to the ER generally cost more than those to other places of care. You’ll generally have a higher copay (a fixed cost) or coinsurance (a percentage of the cost) for ER visits than for other medical visits.

Your Doctor’s Office

If you’re not having an emergency, you have several options for acute care. One of them is your regular doctor’s office.

Your primary care physician (PCP) knows you and your medical history. Your PCP can treat many acute conditions while also keeping track of any chronic (long-lasting) conditions you may have, such as diabetes and asthma. Some types of health plans require you to have a PCP and to have that doctor refer you to specialists if needed. But, even if your health plan doesn’t require that, it’s a good idea to have a PCP.

If you have a PCP and you have a nonemergency acute condition, it can make sense to go to that doctor first. You may have to make an appointment, and the office hours may be limited. But, the doctor will examine and treat you with knowledge of your overall state of health.

Retail Clinics

What if you don’t have a PCP? Or what if you do, but you don’t want to make an appointment or wait for your doctor’s regular hours? If your acute condition is minor, you may decide to have it treated at a retail clinic.

You can find retail clinics in pharmacies, supermarkets and big-box stores. They’re usually open evenings and weekends. You can make an appointment or just walk in. But, retail clinics treat a limited range of conditions. They treat minor, common complaints like ear infections, allergies and sunburn. Some also give preventive care, such as flu shots. They’re more often staffed by nurse practitioners or physician’s assistants than doctors.

Most health plans cover retail clinics. Even if you’re uninsured and have to pay out of pocket, the prices may be lower at a retail clinic than in other places of care.

Urgent Care Centers

Suppose your acute condition is too severe for a retail clinic, but not so serious that it should only be treated in an ER. And, suppose you don’t want to wait until your doctor’s office is open. Then, an urgent care center may be right for you.

Like retail clinics, urgent care centers provide care after regular business hours and on weekends. You can make an appointment or walk in. They can treat infections, sprains, broken bones, cuts that require stitches and many other conditions. They usually have their own labs and X-ray machines. But, they’re not suited for major wounds, heart attacks or strokes. Those should be treated in the ER.

Most health plans have urgent care centers in their networks. The copay for an urgent care center is usually higher than for a PCP but lower than for an ER.

You have choices about where to get your acute condition treated. And, some choices may save you money.