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Be a Wise Healthcare Consumer

Where Should I Go For Treatment: Doctor’s Office, Retail Clinic, Urgent Care Center, or Emergency Room?

It may be challenging to decide where to find medical treatment when you are ill or injured and think you may need to be seen immediately. Even illnesses or injuries that may seem minor may be determined by the urgent care physician to warrant emergency evaluation and result in a recommendation that you be transferred to the hospital’s emergency room for further treatment. Often your primary care physician can offer guidance, and when necessary, direct you to the appropriate care facility. If you are unable to reach your primary care physician or you do not have one, you should go to the hospital’s emergency department for very serious or life-threatening problems.

During certain healthcare events, it is easy to know when you should go to an emergency room (ER) to receive treatment. In general, conditions that should be evaluated in an Emergency Department include:

The most recent UT SELECT Medical year-end utilization statistics show 20,850 enrollees in the UT SELECT Medical Plan visited the ER during Plan Year 2009-2010. Undoubtedly, the vast majority of the 2009-2010 ER visits were the result of an individual’s need to seek treatment based upon one of the above criteria.

Of the 20,850 individuals with ER visits in the previous plan year, 16,714 visited the ER one time, 2,962 visited the ER two times, and 1,174 visited three or more times. The UT SELECT Medical Plan paid $32,495,344 for 27,131 total ER visits in 2009-2010. With each of those visits, UT SELECT enrollees presumably paid the copayment per visit, a total of approximately $2,713,100.

While there is no better place than an ER to receive treatment when one believes their health is in immediate danger, there are a number of treatment alternatives for less severe matters which can save enrollees, and the UT SELECT Medical plan, a substantial sum of money.

The following reference guide was provided to UT System by Blue Cross and Blue Shield of Texas, and may be a useful resource in helping determine the best treatment options for you and your family members. If you are certain that you do not have a medical emergency (chest pains, bleeding that won’t stop, etc.), the different options below present opportunities for treatment which can save money for both the member and the UT SELECT Medical plan.

Quick reference guide for network treatment resources

Care Option

Hours

Typical Cost*

Description

Doctor’s Office

Office hours vary

$30 Primary Care Provider; $35 Specialist

Your doctor’s office is generally the best place to go for non-emergency care such as health exams, colds, flu, sore throats, minor injuries, aches and pains.

Retail Health Clinic

Example: MinuteClinic (CVS)

Similar to retail store hours

$30 or $35

Walk-in clinics are often located in stores and pharmacies to provide convenient, low-cost treatment for minor medical problems like ear infections, athlete’s foot, bronchitis and some vaccinations.

Urgent Care Provider

Generally include evenings, weekends and holidays

$35

Urgent care centers provide care when your doctor is not available, and you don’t have a true emergency. For example, they can treat sprained ankles, fevers, and minor cuts and injuries.

Emergency Room (ER)

24 hours, seven days a week

$150 Copayment

An emergency means you could die, lose the use of a limb or organ, or otherwise place your health in serious jeopardy if you don’t get care quickly. For serious, life-threatening conditions, you need emergency care. For medical emergencies, call 911 or your local emergency services first.

24/7 Nurseline
888-315-9473

Available 24 hours a day, seven days a week;
bilingual nurses available

The 24/7 Nurseline can help you:
• Decide if a situation is an emergency
• Answer health-related questions
• Understand your condition

* Typical cost based upon treatment from BCBSTX network provider.

You should be aware that you may incur additional expenses if you seek emergency treatment at an emergency care center in a facility that is:

Urgent care clinics fill the gap between primary care offices and ERs by providing basic patient care in a health clinic setting.  As an enrollee in UT SELECT you have a robust benefit in that you do not have a separate, higher urgent care copayment, unlike many health plans. In order to be prepared for times when your primary care provider is unavailable but you don’t require the elevated level of care of an ER, you can locate urgent care centers in your area by using the provider finder on Blue Access for Members at www.bcbstx.com/ut. Call the centers nearest and confirm that they will file claims as an urgent care facility rather than an emergency room. If you have any questions, please contact BCBSTX Customer Service at (800) 252-8039.

You should keep in mind certain things when deciding to utilize urgent care facilities. First, and most importantly, patients need to determine whether they need immediate care or emergency care.  True medical emergencies such as chest pain, difficulty breathing, and stroke-like symptoms cannot be treated at an urgent care clinic.  Also, any patient with a serious traumatic injury should not be taken to an urgent care clinic.  Serious bleeding, suspected brain injuries (concussions or any loss of consciousness), and major fractures - that is, anything that would require a hard cast - require the services of an ER.  If there is any question about whether a problem is an emergency, go directly to the ER or call 911.