Photo of boy with broken leg in hospital
May 28, 2021 | Tags: Insurance education

When you or a loved one is ill or injured, quick treatment is your top priority. But unless you think your problem is immediately life threatening, it’s best to call your primary care provider (PCP) before heading to the emergency room (ER). Your PCP can discuss your symptoms and tell you where to get the proper care and avoid any unnecessary medical costs.

Below, we’ll discuss when is the right time to visit the ER, an urgent care clinic or convenience clinic.

When to Use the Emergency Room

The ER is best for treating life-threating conditions and injuries in need of immediate care. Since ER staffs are trained to treat these high priority patients first, anyone sitting in the waiting room with a non-emergency symptom like a sore throat or low-grade fever could be left waiting for long periods of time. ER visits can also result in expensive out-of-pocket costs because many insurance plans include higher ER copays or don’t cover ER visits at all if the situation is not determined to be a true emergency.

You should turn to an ER in instances of:

  • Compound fractures
  • Seizures
  • Major head injuries
  • Severe pains
  • Poison ingestion
  • Animal bites
  • Severe burns
  • Chest pains or symptoms of heart attack
  • Any symptom or injury that is threatening the patient’s life

Be sure to understand how your ER coverage works with your insurance plan to avoid unexpected bills and only go to the ER in the case of a true emergency.

Non-emergency Options to Receive Care

Medical Mutual wants you to get treated at the right place and with the efficiency, quality and attention you deserve. If you have a minor illness or injury you think requires prompt attention, but can’t reach your PCP, urgent care clinics and convenience clinics are good, and usually less costly, alternatives to the ER.

Urgent Care Clinic

Not only will you save time, but you’ll save money. Urgent care clinics offer shorter waiting times, and sometimes you can be seen immediately. Some clinics are open 24/7 and most others have extended hours (early morning, late evening and weekend hours). Clinic staff members are specially trained in treating minor injuries and illness, and they will recognize if a higher level of care is needed and refer you appropriately.

An urgent care clinic can help you with:

  • Asthma and wheezing
  • Back pain
  • Colds and flu
  • Ear or eye infections
  • Minor allergic reactions
  • Minor lacerations or burns
  • Rashes
  • Respiratory infections
  • Sore throats
  • Sprains or strains
  • Urinary and kidney tract infections

Convenience Clinics

Convenience clinics are another good option for treating minor illnesses and injuries. These clinics are often located in drug stores and grocery stores and are staffed by nurse practitioners or physician assistants who can diagnose and treat many illnesses and write prescriptions.

A convenience clinic can help you with:

  • Sore throat or bronchitis
  • Pink eye
  • Ear infections
  • Various vaccinations

Finally, if you receive treatment from an urgent care or convenience clinic, don’t forget to schedule a follow-up appointment with your PCP to discuss the course of treatment prescribed and see if further instructions are needed.

Finding a Facility

When looking for an ER, urgent care or convenience clinic, it’s important to always check that the facility is in your health insurance network to avoid expensive out-of-pocket costs. If you are already a Medical Mutual member, finding a facility is easy with our Find a Provider tool.

The material provided is for your information only. It does not take the place of your doctor’s advice, diagnosis or treatment. You should make decisions about your care with your doctor. What is covered by your health insurance will be based on your specific benefit plan.