Two Ways Your Insurance Provider May Treat Your Urgent Care Bill Differently

Urgent care facilities are the perfect place to go when you have a critical health problem that's not severe enough for the emergency room but you can't wait to see your primary care physician about. While most insurance providers do cover the cost of care obtained at urgent care centers, they often handle those bills a little differently than bills from the policyholders' regular doctors. Here's what you need to know to prepare yourself.

Higher Co-Pays May Apply

One way insurance companies treat urgent care centers differently is they usually charge higher co-pays for visiting them. This is because urgent care centers have higher costs due to the nature of the facility. They must purchase expensive equipment (e.g. x-ray machines, heart monitors) to help them diagnose issues on the spot. They must also have more staff on hand at all times to ensure patients are seen in a timely manner.

As a result of this, urgent care centers tend to charge more for their services. In anticipation of receiving a larger bill from the facility, health insurance providers typically require policyholders to pay a little on the co-payment portion. The amount will vary depending on your plan. For instance, the average co-pay for urgent care is $75 if you have a PPO plan vs. $25 for primary care physicians. HMO plans tend to charge less.

Be sure to consult your insurance paperwork or contact your provider to determine if there's a cost difference and be prepared to pay it when you get to the center.

You May Not Have to Pay the Deductible

Almost all insurance plans require policyholders to pay a deductible before the company will begin paying for their medical bills. This is true when you get care from your primary physician or the emergency room. However, some insurance providers do exclude visits to urgent care centers from this requirement and will pay the bill even if you haven't met the deductible for your plan.

Again, read your policy to determine if this applies to you. Don't worry, though, if you do have to pay your deductible. You generally won't have to pay for the visit on the spot. The urgent care center will send the bill to your insurance provider, and your provider will typically subtract your deductible from the balance, pay what's left, and forward the bill to you (or back to the center's billing department). This can provide you with more time to come up with the money to pay if you're short on cash when you visit the facility.

For more information about this issue or to get care for a pressing health concern, contact a local urgent care center, like La Costa Urgent Care.