The necessity of seeking care at an Emergency Room when urgent or after-hours care is needed is not often a decision considered prior to the occurrence of a medical event.
Emergency rooms can make you wait a long time for care for a non-emergent situation. In addition, the cost of treatment is often five times more than the cost of treatment at a primary care office, or an Urgent Care center.
When treatment is needed after normal office hours (after 5:00 PM or on the weekend), the decision as to which type of facility to use is typically one that must be made quickly. Using an Emergency Room is often a person’s first thought, but it is not the only option available to you.
Under the Fund’s Plan of benefits, the cost of treatment at an Emergency Room is only covered by the Plan if it is determined by the Fund to be a true emergency. For example, if you have a low grade fever and headache and go to the Emergency Room, that would likely be considered non-emergent and your claim will probably be denied, leaving you to pay the entire Emergency Room bill. As an alternative for non-emergent situations, Urgent Care facilities, which are typically open in the evenings and on weekends, can provide similar treatment to an emergency room for non-emergency situations in a more timely and cost effective manner.
Click below for a one-page guidance chart for your reference to keep in mind should you require after hours care. See the section titled “Need to Find an Alternative to the ER?” for assistance in locating in network Urgent Care and Retail Health Centers.
As with your regular care, the Fund only covers in network facilities, including these types of care centers.
The chart is only a guide — only you can determine the best place to seek medical care. Of course, in the event of a true medical emergency, you should not hesitate to call 911 or proceed directly to the Emergency Room.
Otherwise, it’s best to get care at an in-network urgent care facility or your doctor’s office.