blue cross blue shield copay emergency room

In contrast, an urgent care facility inside a pharmacy might charge lower costs since there are fewer overhead expenses. Costs can also be higher if a facility purchases and maintains expensive medical equipment. That is because the cost of rent in some areas is higher. For example, costs are likely higher in Manhattan than they are in a smaller city or a rural area. Where you seek urgent care services might impact the cost you pay. Several factors determine how much you will pay for urgent care services, including location, insurance and services. What Factors Into the Cost of Urgent Care?

Patients without insurance pay on average twice as much for health care as patients who have insurance, according to the federal government.įailing to carry health insurance puts you at enormous financial risk, particularly if you’re suddenly diagnosed with a difficult and expensive condition. But you should not count on this or expect it to be easy.Ī much better alternative is to have health insurance. You might also be able to negotiate the standard fee even lower or work out a payment plan that makes the cost more affordable. Without health insurance, you will be on the hook for the entire fee.įortunately many urgent care centers offer discounted rates for those who pay out of pocket for their care. The cost of paying for health care services, including urgent care, typically increases significantly if you don’t have health insurance.įor example, if you cut your finger and need a few stitches, it will cost you $150 on average at an urgent care facility, according to a Forbes analysis. Saying it participates in your insurance means it’s in-network and contracts with your insurance company.Īlso, make sure you search for the best affordable health insurance plan that meets your needs and covers your costs, including visiting an urgent care facility. Merely asking if it “accepts” your health insurance is not enough since accepting insurance can still mean it’s considered an out-of-network provider. The new No Surprises Act, which sets up a process to help people avoid surprise medical billing, doesn’t pertain to urgent care.Īsk an urgent care facility if it “participates” in your health plan to avoid such charges. But if the urgent care facility you choose is not a preferred provider, you might be responsible for these costs. If your urgent care provider is a preferred provider-meaning it contracted with your health insurer or plan to provide services at a discount-it’s prohibited from engaging in balance billing. For example, “balance billing” occurs when a health care provider bills you for the difference between the provider’s charge and the allowed amount. And in some cases, you might be surprised with additional charges. If you go out of network, your charges for an urgent care facility can be much higher.

For example, your insurer may pick up 80% of the cost while you’re responsible for 20% until you hit this annual out-of-pocket maximum. Once you reach your plan’s deductible, the insurance company pays a portion of your costs, which is the coinsurance portion of health insurance.Ĭoinsurance: After you reach your plan’s deductible, health insurance plans typically require policyholders to pay for a percentage of their care up to an out-of-pocket maximum, which is called coinsurance.

Many insurance plans have annual deductibles of at least $1,500 for an individual or $3,000 for family coverage in 2023, which qualifies it as a high-deductible health plan (HDHP). Usually, copays at urgent care facilities are lower than the copay you would owe visiting an emergency room.ĭeductible: A health insurance deductible is the amount you owe out of pocket for health care services before your health insurance kicks in. The amount of the copay should be spelled out by your insurer, so you will know in advance how much you owe during your visit. There are multiple types of costs you may pay if you visit an urgent care center:Ĭopay: A copay is a fee you pay at the time of the urgent care visit. Other plans like health maintenance organization (HMO) and exclusive provider organization (EPO) plans typically won’t pay for out-of-network care.Ĭheck with your health insurer long before you need health care services, so you know which urgent care facilities in your community are in your insurer’s plan. Preferred provider organization (PPO) plans generally let you get care outside the plan’s network but at a higher cost. When choosing an urgent care center, look for a facility in your health insurance plan’s provider network. On Healthcare Marketplace's Website Urgent Care Visit Cost With Insurance

Blue cross blue shield copay emergency room