When to visit: Primary care, urgent care or emergency room?

Understanding your health care options

When you’re feeling sick or are injured, there are several options for medical care: a doctor’s office, an urgent care center, a retail health clinic or the emergency room. Here’s a quick guide to help you know where to go, based on the urgency of your ailment.

Blue Cross and Blue Shield (BCBS) members can visit the BCBS Provider Finder to find in-network providers. This includes doctors, hospitals, specialists and more. You can also log onto your local BCBS company's site.

Primary care physician: routine and preventive care

Your primary care physician is your go-to provider for routine check-ups, preventive care and non-emergency health issues. They help manage ongoing health conditions and can refer you to specialists when needed.

Your doctor knows your health history, including what medications you are taking and what chronic conditions might need to be considered in your treatment. Additionally, copayments for office visits are typically lower than those for emergency room visits.

If your primary care doctor is unavailable or not the appropriate specialist, they can provide referrals to specialists or other health care professionals.

If you don’t have a primary care physician, take some time to review the options in your network and select one.

Urgent care & retail health clinics: Quick and affordable care

Urgent care centers and retail health clinics are affordable and convenient options if your doctor isn’t available. Retail health clinics are walk-in clinics found in many large pharmacies and stores.

When to go to retail health clinics and urgent care:

• Moderate illnesses and injuries: Colds, flu, earache or eye pain, sore throat, minor cuts and burns, sprains and strains
• When you need care right away but it's not life-threatening
• If your doctor's office is closed

Urgent care centers treat more serious, non-life-threatening issues and offer services like lab tests and X-rays. Retail clinics handle minor illnesses and injuries, usually staffed by nurse practitioners or physician assistants.
 
In most cases, the out-of-pocket cost for visiting a retail health clinic or urgent care center will cost less than a trip to the emergency room. However, it’s a good idea to confirm that your selected health care location is covered by your insurance plan.
 
You can find a list of the urgent care centers in your network on your BCBS company’s website, or by calling the 1-800 number on the back of your member ID card.

24-hour nurse line: Phone consultations

Your BCBS plan may offer a 24-hour nurse line, which you can call any time with questions about your symptoms, complications from medications or advice on when to go to the doctor or emergency room.

To find out if your BCBS company offers this service, or to locate the toll-free number to your local nurse line, check the back of your BCBS member ID.

Emergency rooms: Critical treatment for life-threatening conditions

The emergency room is designed to treat serious, acute and life-threatening health situations. If you feel you are dealing with a health emergency, call 911 or go to the nearest emergency room right away.
 
Otherwise, one of the above options will save you time and money and clear the way for patients in need of emergency treatment. BCBS members can use the BCBS Provider Finder to find nearby emergency rooms.

Making informed decisions about your health care

In conclusion, making informed decisions about your health care is crucial for ensuring you receive the appropriate treatment at the right time. By understanding the differences, you can navigate your health care options more effectively. Empowering yourself with this knowledge ensures that you can focus on what truly matters: your health and well-being.