Where you need to go: ER vs. Urgent Care

Where you need to go: ER vs. Urgent Care
There are more than 10,000 medical clinics that have sprouted up around the nation. These offer the possibility of a shorter wait and a cheaper bill. The only hitch: Not all clinics are created equal. They range from nurse-staffed facilities to freestanding ERs. Hobble into the first type, and you may be out a co-pay before being sent elsewhere to get an X-ray; the second type could be as costly as a hospital ER, even if your problem is relatively minor. Here's how to make the right choice for your health and your wallet.

First: Call your doctor.
If you're not facing a life-threatening emergency, give your own doctor a call: You may be surprised at the hours your primary care physician keeps. In a survey of family physicians, 72% of them offered same-day appointments for urgent matters, and 45% had extended hours outside the standard 9 to 5.

If you can't reach your doctor and you're worried the situation might be dire, you have three choices beyond the hospital ER:

1. For life-threatening problems...
Freestanding emergency centers are open 24/7, so they are a boon in a true crisis when there's no nearby hospital or you want to avoid a long wait. The ER physicians on staff can deal with serious fractures and life-threatening problems such as uncontrolled bleeding, heart attacks, strokes, and poisonings. They'll even help deliver a child. (And if they can't handle your issue, they can transfer you to a hospital.) While co-pays have been changing, they've been about $75 to $100, although your total bill may be much higher; you wouldn't want to go to one of these centers for conditions that could be treated elsewhere. They usually accept insurance, but check to make sure the one you're headed for takes your particular plan. One caveat: While almost all freestanding ERs — like hospital ERs — will treat everyone regardless of coverage, some may turn away the uninsured.

2. For serious injuries...
Urgent care clinics are usually staffed by a combination of M.D.'s, physician assistants, and nurse practitioners, and they can handle serious — but not life-threatening — problems like sprains, strains, and minor fractures (most have imaging equipment). The staff on hand can also manage mild allergic or asthmatic reactions, infections and animal bites; stitch up cuts; and prescribe any medication you might need. These clinics are open at least 10 to 12 hours a day, six to seven days a week; co-pays have been around $35 to $75 (though again, you'll want to verify that the clinic accepts your insurance).

3. For minor concerns...
Retail clinics can often be found in pharmacies and big-box stores such as Walmart, and they're usually staffed by nurse practitioners and physician assistants who are overseen by an off-site M.D. The clinics offer wellness care such as vaccinations, physicals, and blood tests, but they can also come in handy when you can't get in to see a doctor for a worrisome rash, a questionable cut, a minor burn, an earache, or persistent cold or flu symptoms. You'll find that the hours vary, but the clinics are typically open 10 to 12 hours a day. Co-pays have been in the $15 to $30 range — but be sure to confirm that your insurance is accepted.

Go directly to an ER if you have:
Any serious injury to life or limb — especially one that triggers a sense of dread or doom, say physicians. The body releases substances such as stress chemicals after you've suffered serious trauma, so don't ignore that feeling. Problems that can trigger this sense include:
• Heart attack
• Stroke
• A severe allergic reaction
• A high fever with a stiff neck
• Sudden, severe abdominal pain

Is it an emergency?
Sometimes you face a condition that's neither minor (i.e., treatable at a retail clinic) nor an obvious emergency. The chart below can help you decide if you need urgent care or the ER: