Emergency Rooms vs Urgent Care Clinics: The True Cost

The polarizing debate about whether one can receive care more optimally at an emergency room of a hospital or an urgent care clinic has lasted for years and continues to this day.

When it comes to costs, urgent care clinics certainly beat out emergency rooms. This is an especially relevant factor to those concerned about medical debt. For many families, who may be dealing with multiple emergencies annually, the medical debt incurred by repeated visits to the ER could end up being crushing, which is why many opt to visit urgent care centers instead.

On the flip side, hospitals are generally supplied with far more equipment, operate around the clock, and are typically more densely staffed than urgent care centers.

Conditions that are not life-threatening, those that do not require immediate assistance with, or do not entail the usage of specialized equipment, such as broken bones, allergic reactions, minor lacerations, bites, flu symptoms, or fevers, are typically better addressed in urgent care centers.

Those emergencies that put one’s life in peril such as severe burns, strokes, heart attacks, or electrical shocks, are better served by the equipment and services offered in an emergency room.

Emergency Rooms

Emergency rooms see a lot of visitors annually. In 2016, the nearly 5,000 emergency rooms around the US hosted around 145 million patient visits, with 23 million of those originating via emergency ambulance arrival. In fact, close to half (about 43%) of all hospital stays are transfers from those who arrive at the emergency room first.

Typically emergency room visits deal with injuries that can be classified into 5 different levels ranging from Level 1 (minor problem like an earache) to Level 5 (such as a broken bone or torn muscle). The staggering number of visits to the ER for minor problems might be surprising considering that urgent care centers are options in many parts of the country, but there is a reason that number is so large. There is a legal directive for emergency rooms to treat all patients who visit regardless of whether they can pay for their visit or not. 

Many patients cannot afford the often high costs of doctor’s visits. Per the legal directive, however, emergency rooms must treat everyone, regardless of their ability to pay, something doctor’s offices are not obligated to do. This drives those who are financially strapped already to utilize their emergency rooms for health-related visits that would normally be addressed at a primary care visit. These minor issues weave in with an inflow of real, genuine emergencies, so ERs are put under a tremendous amount of pressure when it comes to deal with arrivals with life-threatening conditions.

If those patients rely on the ER for their non-urgent conditions, many of which are avoidable with preventative health care or annual screenings at a doctors’ office, it is estimated that the annual savings could total to as much as $18 billion.

Urgent Care Clinics

Primary doctors are commonly not available on weekends and are rarely able to see patients at night. This drove a lot of patients to take their medical needs to the ER, until the 1990s when urgent care clinics started popping up to bridge the gap between the two. Since then, urgent care centers serve 73% of Americans who may not have access to their doctors at that time. 

While most of the 9,300 urgent care clinics are not open 24/7, they tend to be open until around 9 pm and seldom require an appointment. The staff at these centers are typically made up of ER physicians and practitioners of family medicine that can perform nearly any procedure without necessitating an ER visit. There are, however, two notable exceptions:

• Unlike a primary provider’s office, it is a one-and-done visit. No records for a particular patient are retained as they would be in a primary’s office.
• Hospitals usually have very sophisticated equipment that deals with life-threatening conditions, while nearly all urgent care centers do not.

This is not to say that they are not sufficiently equipped. Between lab testing capabilities and X-ray equipment, an urgent care center can cast broken bones, perform flu shots, and perform nearly everything in between. The visits typically cost between $100 and $150, with most procedures covered by medical insurance.

There are also entities known as walk-in clinics. These differ from urgent care centers in that urgent care centers are staffed by physicians, while walk-in clinics typically employ nurse practitioners. These can be found in many retail and grocery stores, as well as pharmacies, and can treat many minor conditions like sprains, colds, and flues.

How To Choose Between Emergency Rooms And Urgent Care Clinics

The decision between heading to an emergency room or an urgent care clinic is sometimes a matter of financial affordability, but more often than not it’s a matter of convenience instead. Because emergency rooms provide service around the clock, and there are more than 5,000 of them around the country to choose from, people know they can head to the ER whenever and wherever they want to.

The National Hospital Ambulatory Medical Care Survey found that about 33% percent of those coming into the ER are actually seeking assistance with non-urgent matters. The American College of Physicians has found, however, that the great majority of visits are from patients who need assistance either immediately or very expediently. Research from the New England Health Institute found that over half of the visits to the emergency room (roughly 56% could be avoided entirely). Many other studies have found that a significant number of visits are concerning issues that could be addressed entirely at urgent care centers instead.

In 2018, for instance, the cumulative amount spent on healthcare was a stunning $3.65 trillion. 

It should come as little surprise then, that medical debt is the leading cause of bankruptcy in the US. Yet people continue to visit emergency rooms, which results in them incurring far higher costs than those who opt to go to urgent care clinics. From this, one might conclude that if people had better knowledge about and understanding of emergency rooms and urgent care centers, the dramatic expenditure and medical debt incurred by many Americans would be far less than it currently is.

Suitable Cases To Visit The ER

To determine if the ER is the more suitable choice or if an urgent clinic makes more sense, the main question patients must ask is why they are going in the first place. The answer is cut and dry: unless one’s condition is life-threatening, be it from injuries or symptoms they are experiencing, going to an urgent clinic is the better option. 

Of course, there are situations when a patient simply does not know enough about their own medical situation to tell if their symptoms warrant an emergency room visit. They rely on a medical professional to evaluate their symptoms, and since they are unsure, the safer bet is to go to the ER. 

The best rule to go by is to follow sensible logic in this decision. If one’s condition can result in long-term impairment to one’s health or could lead to death, going to the ER is the right solution.

While there is no concrete list of symptoms for which one should definitely choose the emergency room over an urgent clinic, the following list is the typical symptoms which people can reliably know they need to head to the ER for:

• Intestinal bleeding
• Severe chest or abdominal pains
• Shortness of breath
• Perpetual vomiting
• Paralysis
• Eye or severe head injuries
• Unconsciousness
• For pregnant women, vaginal bleeding
• For children especially, rashes or high fevers
• Allergic reactions
• Poisoning

What Can Be Treated At An Urgent Care Center?

Those conditions that are non-life-threatening, but do need to be attended to that day, are ones that are best suited for an urgent care clinic like NeuMed.

Conditions that we treat include: 

• Seasonal allergies
• Flu symptoms
• Cold symptoms
• Fevers
• Broken bones or sprains
• Ear infections
• Moderate asthma or other mild breathing issues
• Bronchitis
• Insect bites
• Animal bites
• UTIs
• Abdominal pain
• Back pain
• Vomiting
• Diarrhea
• Gashes or cuts requiring stitches
• Need for lab tests or X-rays
• Screenings
• Chronic disease management

If the conditions are more severe than any of the above, the patient needs to head to the ER. In many of those situations, being taken to the ER via an ambulance and getting treated on the way could be the difference between life and death.

Urgent Care Is Less Expensive And Timely

Depending on the level of treatment received at a hospital emergency room, one visit can cost between $100 to $150. Urgent care center visits are almost always covered by medical insurance, with the cost being only the regular copay. Even if that copay is $50, it still amounts to far lower costs than a hospital visit. Of course, costs for either treatment facility for uninsured patients are much higher. In 2017, the Health Care Institute estimated that the cost of an ER visit is about $1,389.

From a time perspective, urgent care centers also have the edge. Patients, there are seen on a first come first serve basis, while at emergency rooms patients get seen based on condition severity. The average visit times at emergency rooms are about 2 hours and 15 minutes from the time the patient arrives at the time they are treated and dismissed, while urgent care center visits tend to average at about 30 minutes.

Comparing The Costs

In 2010, Medica Choice Network put together a list of the most common reasons people visit ERs or urgent care facilities and calculated the average costs to individuals seeking treatments for them based on where they are receiving treatments.

 Most estimates put urgent care procedures at between $71 and $125 to be treated, while certain ones like UTIs, middle ear infections, and pharyngitis can cost as much as $155. No matter how it’s broken down, urgent care costs are less than ER visits across the board.

Prudent Layperson Standard (PLS)

There is one other important and outstanding factor that has yet to be mentioned as a basis of a patient’s decision of where to go for treatment. This is known as the Prudent Layperson Standard (aka PLS). This is simply when a person with some modest knowledge about health and medicine believes that their conditions would cause significant harm to either their life or the health of a vital organ.

This is the standard that insurance companies apply to decide whether they will cover the visit or how much of it they will cover. If the person could have gone to an urgent care center for the condition but opted not to, insurance companies may be more resistant to help pay for the medical claims. So, for instance, if a patient goes to an emergency room for a sprained ankle, sore throat, or a cough, conditions that urgent care centers or walk-in clinics could easily handle, their insurance company could theoretically deny them coverage, leaving the patient to fork over the costs out of pocket. This puts a lot of pressure on patients who need to fill up their credit cards or take out loans to repay the debts.

There is no hard line on this standard of course. If the symptoms experienced could be related to a more severe condition, the person may opt for an ER visit, even if ultimately it ends up being diagnosed as something less severe. These borderline cases are accounted for, and insurance companies will typically pay for those claims. However, this is a necessary tool that insurance companies leverage to discourage frivolous ER visits that only serve to overburden overworked nurses and providers and run up the country’s medical debt.

Some patients who are denied coverage may fully believe that their visit to the ER was justified. There is an appeals process in cases like this. In 2011, it was found that 39% to 59% of such appeals were ultimately successful. 

Visiting The ER While Uninsured

Emergency rooms must treat everyone who comes, regardless of their ability to pay for the treatment according to the 1986 Emergency Medical Treatment And Active Labor Act. However, this will in no way stop a patient from being billed for the treatment afterward. So what about those who are uninsured? They will still be treated, but when they cannot make payment, who foots the bill?

Partially it is covered by the federal government who reimburses the hospitals for these treatments, but far from the full amount that they are typically charging for the visit. In that sense, the rest of the cost is absorbed by the hospital itself is a term referred to as “uncompensated care.” However, patients will not simply be off the hook for these payments. They will be charged, and their delinquency will be reported to collection agencies who will work out a plan to get at least part of that payment paid back.

Visiting An Urgent Care Center While Uninsured

Unlike the emergency rooms at hospitals that cannot legally turn anyone requiring care away, urgent care centers are not bound by such limitations. While one can show up to seek treatment while uninsured, if they cannot provide a way to pay (credit card, check, billing plan, etc.) the urgent care clinic can turn them away.

What the visit will cost depends largely on the type of condition being treated. In fact, the prices for treating most conditions are listed out so that uninsured are aware of what they will owe for the services. If they can pay, their visits will typically cost between $100 and $150.

ER Costs Add Up Quickly

While most Americans are inserted, a great many of them are in plans with high deductibles, according to the Kaiser Family Foundation. In 2017, they found that these high deductible plans do not allow insurance to start paying until the patient has incurred at least $1,217 in medical debt, and those are the better plans. Most do not kick in until $2,500 has been spent on an individual or $5,000 per family.

When a patient visits the ER, they may require lab tests, X-rays, or more complicated procedures, the costs of which are all added up to the already high cost of their visit. These factors total to an amount over the deductible, triggering the insurance coverage, but also mean that enough was spent to put a serious financial burden on the patient who will be on the hook for their owed amount.

All of this doesn’t even account for ambulance travel. If a patient didn’t drive themselves or have someone bring them to the ER, depending on their insurance status, a trip in the ambulance will cost anywhere between $25 to $1,200. If the emergency room the patient arrives in is out of network for their insurance, the visit may not be covered. Even if the hospital is in-network, but the treating physician is not, the patient may still be on the hook for the entire cost of the visit.

Best Practices For Paying Off ER Bills

If the emergency room visit is more than one can afford, there are a few tips that can be applied to paying it off:

• Talk to the billing department about various costs for similar procedures, and request to be billed for the lowest one. You can also ask them how else you can cut the costs of your visit down somewhat.
• It is important to request an itemized accounting list of charges for treatments. Medical billing isn’t perfect, and people can get charged for more than they were treated for, as well as for incorrect medications and treatments. If you are unsure, you can request that your primary physician take a look at the itemized bill to help determine if all the things included in it were pertinent to your visit.
• Work out a payment plan with the hospital. They don’t want to refer your bill to a collection agency either, so if you communicate how much you can pay per month, they can help set up a plan that works for you.
• Many hospitals are affiliated with charities that help patients who cannot afford their bills pay them off. Talk to the hospital about these and find out if they can help you.
• There are multiple crowdfunding sites where people can request assistance with medical bills. This is a reaching-out mechanism that appeals to people’s philanthropic nature. You can explain how high the bill is and tell your story. You will likely find some empathetic supporters who will help you pay your bills.
• Severe cases that result in emergency room visits can result in unmanageable costs. Some patients consider bankruptcy in these situations. Because medical debts are unsecured, if bankruptcy is filed, this is the kind of debt that could potentially be dismissed. You will need to consult with a bankruptcy attorney for more information.
• Consolidating your debt into one payment may help you out as well. It will be a long road, but if you put all of your debts into one sum, you can plan out how to pay it off according to your abilities and means.