Does Insurance Cover Urgent Care?

In general, insurance providers do cover visits to Urgent Care Clinics. However, not all insurance products provide this type of coverage and it is important to read your schedule of benefits or contact your insurance provider in order to confirm cover.

The main reason that insurance companies do provide this type of cover is that it is often far more affordable than a visit to the Emergency Room in a hospital at an average cost of $150. It is important to be aware of the limits that may apply.

For example, they may cap or limit the amount that they will pay for a visit, procedures that were performed at the Urgent Care Clinic, tests or materials that were used. These limitations may apply per beneficiary on an annual basis or per visit. There may also be a co-payment that you will be responsible for paying directly to the clinic out of your own pocket.

What Constitutes Urgent Care?

Urgent Care facilities normally offer the following services:

– Treatment for acute illnesses such as a cold, flu, minor aches and pains, etc.
– Treatment and care for minor injuries such as cuts and abrasions.
– Pediatrics that include treatment for acute illnesses and minor injuries.
– Physical examinations and reports.
– X-rays and lab testing such as blood sugar tests and blood panels.
– Some Urgent Care facilities may offer additional treatments such as occupational therapy. Check with your medical insurance provider if any additional treatments will be covered at an Urgent Care Clinic.

When Should You Use Urgent Care?

Urgent Care Clinics are not meant to replace the Emergency Room but rather to see to minor health issues in the same way that a traditional general practitioner would. Except of course that they offer in-house x-rays and other necessary tests which would normally need to be sent to a lab. However, the clinics were set up with the aim to alleviate the pressure on emergency rooms for visits of a nature that did not require immediate medical treatment and therefore did not constitute an emergency freeing up the emergency room for cases that did require emergency treatment.

You won’t need to make an appointment to visit an Urgent Care Facility. Patients are seen on a first come first serve basis or if a matter is extremely urgent, medical treatment should be provided immediately. Should an illness or injury be of a serious nature, patients will be referred to a specialist for treatment or to an emergency room if immediate care is needed. If you have a serious medical condition or sustained an injury that requires immediate treatment or could be life threatening, it is recommended to go to a hospital emergency room for treatment by specialist and qualified medical practitioners.

How The Insurance Companies Pay

In most cases, your medical insurance provider will pay the Urgent Care Clinic directly. This means that you won’t need to pay the clinic and then submit a claim to the medical insurance provider to be reimbursed. At the same time, you do not need medical insurance in order to visit an Urgent Care facility but may be required to pay upfront before any treatment is provided.

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