Urgent care vs. emergency care What should I know? Amid a public health crisis, urgent care and emergency facilities are seeing an increase in the number of patients they treat. Long waits and costly visits are adding to the stress of your condition. Knowing the difference in the services offered at an urgent care and emergency room can give you the care you need and may also save you valuable time and money. Be prepared: Know your health benefits Under your Kern Legacy Health Plan, your co-pay for an urgent care visit is $15 per visit (deductibles may apply), whereas the co-pay for an emergency room visit is $150 (deductibles may apply). (Kern Legacy Classic Choice members have a $75 ER co-pay). If the member received ER or urgent care treatment from a non-network provider, the member may submit a claim form to the claims administrator to be considered for reimbursement. Submitting a claim is not a guarantee of payment and is subject to medical review and Plan guidelines. CAUTION: The use of a non-network hospital, facility or health care provider could result in your having to pay a substantial balance of the provider’s billing. Balance billing occurs when a health care provider bills a patient for charges (other than copayments, coinsurance or deductibles) that exceed the Plan’s payment for a covered service. You can avoid balance billing by using Network/ Contracted providers. Remember, your lowest out-of-pocket costs will occur when you use Network/Contracted providers. YOUR QUESTIONS ANSWERED For questions regarding your urgent care or emergency room benefit or to locate a contracted facility, call the Member Services number on the back of your ID card or visit www.kerncounty healthbenefits.com. Unlike emergency rooms, urgent care centers only treat individuals with illnesses or injuries that are not life-threatening. For individuals who feel they need medical attention but also feel they do not require ER services, urgent care centers may be their best option. The wait times can be drastically shorter, and the costs are significantly less. Common conditions treated in urgent care facilities include: ● Sore throats. ● Earaches. ● Coughs. ● Fevers without a rash. ● Persistent diarrhea. ● Vomiting. ● Sprains or shallow cuts. ● Urinary tract and bladder infections. ● Backaches. It is important to know that ER care is for the treatment of life-threatening conditions. Patients are seen by the severity of their conditions, not by the time they arrive. An individual who presents with an earache may wait up to six hours or longer to obtain services, whereas an individual who presents with chest pains may not wait at all. It is important to know your condition and determine if an ER is actually what you need. Life-threatening conditions may include: ● Severe chest pain. ● Unconsciousness. ● Shortness of breath. ● Major wounds or severe burns. ● High fever with a headache. ● Vaginal bleeding with pregnancy or being in active labor. ● Poisoning or overdose. ● Broken bones. ● Allergic reactions or swelling. When should I go to urgent care? When should I go to an emergency room (ER)?
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