Best-Kept Secret 1: Appropriate use of urgent care

Choosing the right level of care is an important part of using your health benefits effectively. Essentially, it's about knowing when to see your doctor, go to urgent care, or go to the emergency room (ER).

Urgent care centers may provide a good medical and financial alternative when you can't see your regular doctor and the illness or injury is relatively minor.

Cuts, bumps, sprains, flu symptoms, general wound care, fever, allergic reactions, animal bites, mild asthma, a rash, and a sore throat are some cases where you should see your doctor, or consider going to an urgent care facility instead of the emergency room.

If you don't know where the closest urgent care center to your home is, it might be a good idea to find out, so next time you don't have to wait hours in an emergency room.

Emergency rooms are the best choice when you experience a life-threatening condition, severely broken bones, or a major illness.

Advantages of urgent care centers over ER

Opting for an urgent care - also called walk-in - center could gain you some nice advantages over the ER:


  • You'll have a shorter wait at the urgent care center
  • Usually, urgent care centers are open evenings and weekends
  • No appointment is necessary
  • The urgent care center may be closer to your home
  • Your cost is generally lower at an urgent care center than at an emergency room
  • If you go to the ER for a non-emergency, you may end up with a hefty bill to pay
  • Of nearly 100 million people a year that hospital ERs treat, as many as 60 to 80 percent are for non-emergencies -- which overloads the emergency system

Best-Kept Secret 2: Imaging studies options

Diagnostic imaging can be expensive. With many health plans, you could save on out-of-pocket costs by having the study done at a freestanding facility.

In addition to standard X-rays, diagnostic imaging studies include:


  • Computed tomography (CT) scan, also called CAT scan
  • Magnetic resonance imaging (MRI)
  • Magnetic resonance angiography (MRA)
  • Bone mineral density (BMD) or bone density scan
  • Ultrasound scanning, also called sonography
  • Nuclear medicine studies
  • Fluoroscopy studies

Here's a comparison of the average costs for an MRI and a CT scan at in-network hospitals and freestanding facilities. Prices vary by location and by insurer, but your copayment and coinsurance will probably be lower at a freestanding facility.

As shown below, the costs to most health plans are lower at imaging facilities that aren't based in a hospital.

Diagnostic imaging study cost examples

Diagnostic study

In-network hospital

In-network freestanding facility

Cost difference

MRI

$1,035

$617

$418

CT scan

$589

$329

$260

Prices based on national averages.


Advantages of using a freestanding facility:


  • No long wait for an appointment
  • No wait, or only a short wait, on the day of your appointment
  • Lower copayment or coinsurance than you'd pay at a hospital-based facility
  • Convenient, free parking, easy access in and out of the parking lot

Best-Kept Secret 3: Outpatient surgery options

You can usually save on non-emergency outpatient surgery if you go to an ambulatory surgery center (ASC) instead of a hospital. All it takes are a few easy steps.

Review your health benefits plan

Check to see if your benefits include coverage for the procedure. If the surgery is a covered service, ask your doctor if you can go to an ASC. Unlike urgent care centers, ASCs are only for patients referred for outpatient surgery -- not for diagnostic tests or routine medical treatment. Ask your insurer how to find a participating ASC near you.

Surgeries most often performed at ASCs include:


  • Eye surgery, such as cataracts and removal of foreign material
  • Gastroenterology procedures
  • Ear, nose, and throat procedures, such as removal of tonsils and adenoids
  • Gynecological procedures, such as D & Cs and laparoscopies
  • General surgeries, such as cyst removal, biopsies, hernia repair, and hemorrhoid operations
  • Reconstructive surgery
  • Foot surgery, including removal of bunions, corns, and warts, and bone spurs

Compare your (estimated) costs

If your doctor refers you to an ASC, make sure it's an in-network facility. Call the facility before the surgery is scheduled and ask what the charges will be. If the ASC won't give you this information, ask your doctor to recommend another facility that will.

A look at your health plan can show you how your costs differ, depending on where you have the surgery. Let's say your plan requires you to pay copayments and a $500 deductible, and your benefits are 80 percent of costs for in-network services after the deductible. The following example shows how much you could save by using an in-network ASC instead of an in-network hospital. The payments, shown in bold type, are based on the estimated benefits of a PPO plan.

Example of $200 savings on diagnostic tests:


Your costs

In-network hospital

In-network ASC

Copayment

$75

$35

Facility fee*

$2,000

$1,200

Deductible

$500

$500

Balance

$1,500

$700

Your coinsurance payment (20% of balance)

$300

$140

(Your health plan pays 80%)

Your total cost:

$875

$675

*Surgical facility fee only. Does not include estimated costs for doctors’ fees, ambulance services, prostheses, braces, or any services, materials, or equipment not directly related to the surgery.


Advantages of an ASC


  • Safe -- Doctors perform more than 8 million surgeries a year in more than 4,200 ASCs across the United States. Some offer services in multiple specialties, while others limit themselves to one specialty, such as laser eye surgery. All ASCs must have the equipment and staff to care for patients safely.
  • <Highly regulated -- Most undergo stringent licensure, certification, and accreditation reviews. Most ASCs are held to many of the same standards as hospitals. Virtually all states require ASCs to be licensed, just like hospitals.
  • Affordable -- You've already seen how you can save by using an ASC. The Medicare Payment Advisory Commission confirms the "affordability factor" - for 87 percent of procedures, Medicare payments to ASCs are lower than those to hospitals for comparable services. Also, patients often pay less coinsurance for procedures at an ASC than for comparable surgery in a hospital setting.
  • Technologically advanced -- Faster acting and more effective anesthetics and less invasive techniques, such as arthroscopy, make it practical to perform a growing range of procedures in ASCs. Surgeries that used to require major incisions, deep sedation, and extended recoveries are now closed techniques with conscious sedation and minimal recovery time. As medical innovation continues, more procedures will be suitable for an ASC setting.

Emergencies are costly, so make your best treatment decision. Could be, the urgent care center down the street can save you time and money. And, before having an imaging study or outpatient surgery, check out your options and consider a freestanding imaging center or an ASC.