How Much is Urgent Care Without Insurance

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An urgent care center can be helpful when a non-life-threatening illness or injury arises, such as a severe sore throat or a sprained ankle.

While a visit to an urgent care center usually costs more than a medical office appointment, it's often more affordable than going to an emergency room. Plus, urgent care clinics offer the convenience of extended hours and walk-in availability without the need for appointments. However, the cost of an urgent care visit can vary based on several factors, such as your location, the reason for the visit, and the facility's pricing structure.

How much does urgent care cost?

A visit to an urgent care center without insurance can range from $125 to $300, Chelsea Ryckis, president of Ethos Benefits, told GoodRx Health. The average urgent care center visit for minor issues, such as a sprain or small cut, is around $180, according to a study. This is significantly less expensive than a visit to an emergency room for a similar issue, which could cost about $1,720, based on the same study.

However, this is just a baseline cost. If you need additional tests, services, or supplies during your urgent care facility visit, expect to pay more. For example, if lab work or X-rays are needed, your total bill will likely be higher. Similarly, you may have to pay for the costs of orthopedic supplies, such as crutches or a brace, if needed.

Here's what you might pay for common services at urgent care centers in different parts of the country:

What factors affect the cost of urgent care?

Without insurance, the price tag for an urgent care visit can vary quite a bit based on various circumstances. Some of the key factors that impact the cost include:

1. Reason for the visit

The type and severity of the condition are usually the biggest factors in determining the cost of an urgent care visit, Ryckis said. Depending on the nature and complexity of the issue, certain tests and procedures may be needed, which would also affect the cost.

For example, treating a small cut that only requires a simple bandage or skin glue might cost less than treating a large, deep cut that needs stitches. The more complex the condition, the more costly the visit is likely to be.

2. Location

The location of the urgent care center can significantly impact the cost of services. According to Ryckis, the cost of living is typically higher in densely populated cities than in smaller towns or rural regions. This difference in living expenses can also affect healthcare costs.

3. Affiliation

Urgent care centers operated by hospitals can be more expensive than those that are independent or free-standing. Ryckis explained that being part of a larger hospital system means they have higher expenses for staffing, medical equipment, and overhead.

Additionally, hospital-affiliated urgent care centers can charge an extra fee to cover the cost of using the facility. In contrast, independent urgent care centers can be more flexible with their staffing expenses and billing practices, Ryckis said.

4. Pricing structure

Some urgent care centers offer tier-based or bundle services, where they charge a fixed price that includes the medical examination and a few standard tests or treatments. For example, at an urgent care center in Florida, you may pay a flat fee of $199, which includes a consultation, certain medications, wound treatment, and basic lab work.

Other facilities charge separately for each service provided, such as a fee for the exam, another fee for wound care, lab tests, and so on.

Certain centers base the visit fee on a coding system and the level of care provided. The level of care code is determined by many factors, including the time the healthcare professional spends gathering your medical history, ordering tests, reviewing reports, and documenting the visit. For example, a Level 2 new patient visit lasting 15-29 minutes would cost less than a Level 5 visit, which typically can last 60-74 minutes.

5. Medical equipment

If an urgent care center has new or high-end medical equipment, this can also drive up the cost of services. Advanced technology, such as digital X-ray machines or on-site lab testing equipment, can be costly to maintain and operate, Ryckis said. These expenses are generally reflected in the fees.

Does insurance cover urgent care?

Most health insurance plans cover urgent care visits, but your out-of-pocket costs depend on the plan's specifics. Some insurers have a fixed copayment for each urgent care visit, while others may require you to pay a deductible and coinsurance. To understand your specific coverage and costs for urgent care, review your plan's summary of benefits and coverage or call your insurance provider.

Your cost for urgent care with insurance also depends on your plan's approved medical network. The Affordable Care Act (ACA, also known as Obamacare) requires compliant healthcare plans to cover emergency services, even if the facility is out of the plan's network.

However, insurers may treat urgent care differently than emergency care. Some plans might not cover urgent care centers outside of their network of approved facilities. Others may charge higher copays or coinsurance for out-of-network urgent care visits.

Additionally, if you visit an out-of-network urgent care center, you might face balance billing. Balance billing happens when a facility or healthcare professional bills you the difference between what they charge and the allowed amount (what your insurance plan is willing to cover). For example, if the out-of-network urgent care center charges $200 for a visit, but your insurance only allows $100, you could be billed for the remaining $100. This is because urgent care centers are not included in the No Surprises Act, a law that protects consumers from unexpected high medical bills in certain situations.

What are other ways to get help paying for urgent care?

If you don't have insurance or are concerned about the out-of-pocket costs of urgent care, these 10 tips may help you save money on your visit.

1. Consider a virtual visit

If your medical issue can be addressed through a virtual visit or telemedicine, it may be a more affordable option. Some urgent care centers offer lower fees for telemedicine appointments.

"Without insurance, a telemedicine visit can cost between $40 to $100. With insurance, there's usually no copay, but some plans can have a copay built in up to $75," Ryckis said.

2. Choose the right location

Consider whether the urgent care center is an independent facility or affiliated with a hospital. You can usually find this information on the center's website, by asking the staff, or by looking for branding or a logo indicating hospital affiliation.

Independent urgent care centers may have lower costs due to reduced overhead expenses compared with those associated with a larger hospital system.

3. Verify network status

If you have insurance, verify which centers are in your network. This will help you avoid the higher out-of-pocket expenses associated with going to an out-of-network center.

When verifying if an urgent care center is in-network, it's best to contact representatives at your health plan directly rather than at the facility itself. Ryckis explained that you may be told that an urgent care center "accepts" your insurance, but it's actually at the out-of-network reimbursement rate. This could be confusing and lead to higher out-of-pocket costs.

4. Shop around

Before you go, call a few urgent care centers to ask about their costs. Start with the independent centers not affiliated with a hospital, said Ethan Pickner, a health insurance broker at AZ Health & Life Insurance.

You can get an approximate cost for your medical need with or without insurance. Ask how they charge for services, whether it's a bundled price for the visit and certain tests or procedures, or if they bill separately for each service provided.

5. Ask questions

Once at the urgent care center, ask questions about the cost of each service before it's provided. Some important questions to ask include:

• What's my estimated cost for today's visit?

• Are there additional charges that may be billed later?

• Will you discuss all charges with me before providing the service?

• Do you offer payment plan options?

• Are there discounts available for self-pay patients?

• Will you provide an itemized bill for today's visit?

• What are your fees for follow-up visits?

6. Look for discounts

When you're paying without insurance for an urgent care visit, Pickner suggests asking if they offer any discounts that could help lower the total cost. Some urgent care centers provide discounts or seasonal promotions for students, military members, or new patients.

7. Negotiate payment options

Smaller, independent urgent care centers may be more flexible with payment options. For example, if you can't pay the bill at once, they may be willing to set up a payment plan.

They also may offer reduced pricing if you're paying out-of-pocket without insurance. Or they could have a sliding scale based on your income level, where you qualify for discounted rates if you're below a certain household income threshold. Discuss these options ahead of time, Ryckis said.

8. Request an itemized bill

"Make sure you get an itemized bill, so you have more transparency with what is being done," Pickner said.

An itemized bill provides a detailed list of the services you received and their costs. This helps you understand what you're being charged and can help you spot any mistakes or overcharges.

9. Consider Affordable Care Act plans

If you don't have insurance, consider enrolling in an ACA marketplace health plan. According to Pickner, most ACA plans have an urgent care copay of around $75.

What's more, depending on your income, you may qualify for subsidies, such as Cost Sharing Reduction (CSR), when you enroll in an ACA health plan. If you're eligible for CSR, your urgent care copay could be reduced to between $15 and $50, Pickner said.

To see if you qualify for subsidies and to compare ACA health plans, visit your state's marketplace or the federal marketplace at Healthcare.gov.

10. See if you qualify for Medicaid

Medicaid is a state-specific program for low-income individuals. If you qualify for Medicaid, there is generally no cost for urgent care visits, Pickner said. Check your state's Medicaid requirements to see if you're eligible. Keep in mind that not all urgent care centers accept Medicaid.

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GoodRx Holdings Inc. published this content on 22 July 2024 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 22 July 2024 14:24:47 UTC.