Primary Care vs. Urgent Care: What is the Difference? Part 4

Hopefully by now, you have a better understanding of how Urgent Care is different than Primary Care, and how it is also similar.  Today, our last installment will deal with the differences you can expect in costs.

For People with Insurance

When the discussion turns to insurance, most people run for cover.  However, we’ll keep this pretty simple.  Most people will be able to tell what their copayment will be by looking at their insurance cards.  Many of these have a standard copayment price (PC) which you can expect to pay at a Primary Care facility, but some will have other amounts with the terms “UC” and “ER.”  In these cases, the UC amount refers to your Urgent Care copayment, while the ER amount refers to your Hospital Emergency Room copayment.  Often, the UC amount is higher than the PC amount, while the ER amount is the highest of the three.  In these cases you are paying a premium for extra capacity and convenience.  This is not an absolute standard with every insurance company, however, and not every insurance plan requires higher copayments for Urgent Care.

When dealing with your annual deductible, most Primary Care facilities will communicate with your insurance company and determine whether you have met your limit.  You may have to pay more than your copayment up front if you have not met your deductible.  Most Urgent Care facilities, on the other hand, only require the copayment up front.  They will bill your insurance for the balance, and anything that is not paid by them will eventually be billed to you.  They don’t usually worry about figuring out whether you have met your deductible before you receive treatment.

For People without Insurance

When you are paying out of your own pocket, will you pay more at an Urgent Care facility than at a Primary Care doctor?  The actually answer is sometimes yes and sometimes no.  The two medical models bill their patients quite differently.  Primary Care tends to bill by the procedure, so you might have an office visit charge with three or four other charges added on, depending on what you get treated for.  Urgent Care tends to bill by a standard office visit rate.  Extra charges are only added when further testing is required, but the standard office visit rate encompasses quite a bit of service, so often, there are no extra charges.

How does this translate into actual dollars out of your pocket?  A Primary Care office visit price will almost always be less than an Urgent Care office visit.  However, Primary Care adds extra charges for many procedures which are already included in the Urgent Care office visit price.  For simple procedures, the Primary Care facility may be cheaper.  But for many visits, the price of Urgent Care can be quite comparable to Primary Care prices.  Is the higher office visit charge of Urgent Care worth the added convenience and capacity for extra treatment?  For many, it becomes a very good bargain. 

Being informed about the differences in options will hopefully help you to ultimately make the best choice of care for you and your family.