It’s Saturday and your son has a high fever and is pulling at his ear. Your daughter is throwing up and not keeping liquids down, but her pediatrician is closed on weekends. You were hiking with friends and tripped on a tree root. Your wrist is swollen and hurts to move it, but your doctor’s office closes early on Friday.
Do you go to urgent care or the ER when you can’t get to your primary care practice? This choice is important as hospital bills can be substantially higher than urgent care. We have a guide to help you understand the differences in what you pay at an ER vs. urgent care and how insurance rules can impact what you pay.
An Overview of Urgent Care vs. the Hospital’s ER
Urgent care visits are almost always cheaper than an emergency department visit. Staffing and overhead are smaller in an urgent care practice, and there’s less advanced equipment like MRIs, which means prices are lower.
The goal of urgent care is to be a go-between when your primary care physician is unavailable but you need to talk to a doctor. ERs are meant for emergencies. While your need may be urgent, it’s not a potential life-or-death situation.
When to go to an urgent care center:
- Animal bite
- Bone breaks that do not require surgery
- Concerning cold symptoms
- Cuts in need of sutures
- Ear infections
- Flu or COVID symptoms
- Minor burns
- Rash
- Scrapes
- Sprains or strains
- UTIs
- Vaccinations
- Wellness exams before school
- Work physicals
When to go to an ER:
- Bone break with bone appearing through the skin
- Chest pain or suspected heart attack
- High fever in an infant
- Overdose or poisoning
- Severe allergic reaction (anaphylaxis)
- Severe bleeding
- Severe headache
- Stroke
- Third-degree burns
- Vision changes (sudden)
1. Urgent Care Costs
According to Aetna, the average cost for common urgent care services ranges from $110 to $150. This includes care for the flu, headaches, minor cuts and scrapes, and sprains.
Factors that influence your urgent care bill:
- Complexity of your issue (A strep test will cost less than an ankle sprain that requires X-rays.)
- Diagnostic tests (Lab tests cost less than X-rays.)
- Insurance coverage (Is the urgent care in-network or out-of-network? Do you have co-pays or deductions to meet?)
- Location (Different urgent care clinics have their own fee schedules.)
- Medications and fluids (Any medications or fluids that were given are added to the bill.)
- Supplies used (Items like bandages, syringes, sutures, and IV lines increase the total cost.)
- Visit length (Longer exams cost more.)
2. Emergency Room Costs
Hospital visits to an emergency room are generally higher than urgent care. In a 2024 brief from the Agency for Healthcare Research and Quality (AHRQ), the higher cost of ER visits is clear.
There were 107.4 million ER visits in 2021, costing people and insurance companies $80.3 billion. Women statistically pay more than men, and people between the ages of 18 and 45 went to the ER most often. Of those visits, 13.5% were not paid by insurance.
Hospitals are required to share a hospital price index for patients to see what different services cost in area hospitals. Looking at Fresno (Clovis Community Hospital), estimates for common treatments are as follows:
- Arm splint – $577 to $602
- COVID test – $112 to $165.53
- Culture – $62 to $184.41
- Finger splint – $495
- Leg splint – $664 to $865
- Pediatric ED visit – $2,916
- Simple sutures – $943 to $1,968
- Strep test – $105.27 to $204
These prices are without the initial exam and x-rays. Those will increase the amount you or your insurance pays. It also doesn’t consider the negotiated rates your insurance company has set with the hospital. In-network care costs less than out-of-network care.
Key components that contribute to these costs are:
- Ambulance (If you arrived by ambulance, that adds to your bill.)
- Facility fees (Covers staff and equipment)
- Insurance coverage (In-network hospitals have lower negotiated fees than out-of-network hospitals. You also need to consider co-pays and deductibles.)
- Medications and fluids (Any medications or fluids administered during an ER visit increase your bill.)
- Physician fees (Covers the cost of the doctors, surgeons, and specialists)
- Severity (Mild conditions cost less than severe ones due to the amount of time and resources needed.)
- Tests and imaging (Lab work isn’t going to drive up costs as much as necessary EKGs or MRIs would.)
Tips for Avoiding Unexpected Medical Bills
Regardless of where you seek care, it’s important that you know how to avoid unexpected medical bills. The No Surprises Act keeps you from unexpected costs for treatments or items when you seek medical care. For example:
You’re taken to an in-network hospital after a car accident. That hospital cannot charge more than your health insurance company agreed to in a cost-sharing agreement. If your insurance company and the hospital agreed that an X-ray costs $500, the hospital could not bill you for more than $500.
Now, suppose that the hospital is out-of-network. Your insurance company will still only pay $500, but the hospital charges $750 for X-rays. They cannot bill you the additional $250 without you agreeing to pay the extra. Written approval is required, and they cannot ask you to give up your protections.
Californian’s have the right to request and receive a “Good Faith Estimate” that details the cost of your care for non-emergency services and items. This protects you from surprise medical bills. A Good Faith Estimate should cover:
- Medical tests
- Prescription medications
- Equipment used
- Hospital or urgent care fees
When possible, it must be given to you three or more days in advance of your appointment. If your bill is $400 or more than the Good Faith Estimate states, you can dispute the bill.
You still need to protect yourself, too, by making sure you research the following before going to an urgent care or ER.
- Ask for an estimate by calling ahead or asking at the front desk.
- Choose an in-network provider when possible.
- Don’t agree to treatments that are optional if you can’t afford them.
- Research your health insurance coverage and find out how much your co-pay is, if applicable, out-of-pocket maximum, and deductibles.
- Verify that the urgent care or hospital takes your insurance to avoid being out-of-network.
Urgent Care Helps Keep Costs Down
Emergency departments are necessary in some situations, but the care you receive is costly. For medical needs that aren’t life or death, urgent care is the best way to get affordable, convenient care. Seeing your primary care physician is ideal, but it’s not always practical, or you may not have one. If not and it’s not a health crisis, urgent care doctors are an affordable option.
Save money and see a doctor at Premium Urgent Care today. We have extended hours and availability on weekends, which makes urgent care an advantageous option over limited hours at your primary care practice.