Having health insurance means you not only have coverage for the care you need, but you have options of where to get that care. Knowing which option is most appropriate for your immediate need can be confusing. When you have a primary care provider (PCP), primary care after-hours numbers, telehealth, Virtual Health, urgent care providers and an emergency room, how do you know whom to call first?
Here are some simple guidelines to know where you can get the appropriate level of care in a quick and affordable way.
Primary Care Provider
- Everyone should have a primary care provider (PCP). A PCP can be a:
- Medical doctor (MD)
- Doctor of osteopathy (DO)
- Nurse practitioner (APRN)
- Physician’s assistant (PA)
- Primary care means they are your main provider for everything except emergencies. Over time, your PCP becomes familiar with your health history and knows what prescriptions you are taking and any underlying conditions that may affect your care. Your PCP helps you manage your health over the years, whether you suffer from acute illnesses like stomach flu and seasonal allergies or chronic conditions like diabetes, heart disease or cancer.
- Some PCPs offer telemedicine, so you can hold a one-on-one appointment via a private videoconference. If you are looking to be evaluated by your PCP without going to the office, taking advantage of telehealth can be in your best interest. If you are contagious, need a quick follow up visit, or have physical limitations in movement that prevent you from visiting the office. For some conditions, your PCP will need to see you in person. Ask about telehealth options available to you.
- You may have a copay, but your out-of-pocket costs will be less expensive than visiting the emergency room or an urgent care center. Your PCP can also make any referrals if you need to follow up with a specialist.
- If you do not have a PCP, you can use the Find Care and Costs tool within the Blueprint Portal to compare available PCPs who are covered in your network and select one for you or your dependents. After selecting a PCP, contact their office to make your first appointment.
Primary Care After-Hours Number or After-Hours Clinic
- Some PCP clinics have a designated after-hours number to reach an on-call provider. They can answer urgent questions and help you determine if you need to come in during office hours, go to an emergency room or urgent care, or evaluate if your concern can be treated at home.
- Some health systems also offer after-hours clinics for adults or children for needs that arise after the normal clinic hours that do not require emergency room or urgent care resources.
- Cost may vary.
Urgent Care Centers and Walk-in Clinics
- These centers and clinics fill the space between primary care clinics and emergency care or emergency rooms. They are generally walk-in clinics that are open for extended hours.
- Urgent care clinics see patients on a first-come, first-served basis and treat acute illnesses and injuries that don’t warrant the expense of the emergency room. If you have ordinary illnesses like a cold or sore throat, a minor injury like a sprain, cut or fracture, need help with wound care or want to get a flu shot, urgent care is an excellent option if you cannot see your PCP.
- Urgent care centers have MDs, APRNs and PAs on staff who can prescribe medications and order diagnostic tests and X-rays.
- It’s good to call ahead or check your benefits to be sure the center accepts your insurance to avoid any out-of-network fees. Generally, your costs will be lower than those incurred at emergency rooms but more than a copay to your PCP.
- Urgent care clinics also may offer telehealth services. Inquire about the center’s available telemedicine urgent care options.
Virtual Health: Getting Care When and Where You Need It
- Your health plan may include Virtual Health. You can visit with a doctor via video or phone 24/7, 365 days a year from a smartphone or laptop.
- Wait times are typically 10 minutes or less to see a board-certified physician. You will likely see a different physician for each Virtual Health session, which makes it good for occasional use, but not a replacement for the continuity of having a PCP.
- Some conditions seen include allergies, common cold, upset stomach, insect bites, sore throat, pink eye, urinary problems, and some viral illnesses.
- Register for Virtual Health at com or through the Blueprint Portal app. It’s a good idea to register your account and set it up before you need it so it’s ready to go when you do.
Emergency care
- Emergency care or the emergency room is for actual emergencies. These include physical trauma, stroke, chest pain, uncontrolled bleeding, severely high fever, trouble breathing and other immediately dangerous conditions.
- In any life-threatening emergency, call 9-1-1 for help or go directly to the nearest emergency care center or ER.
- ER staff treat patients with the most severe, dangerous and urgent needs first. In nonemergent cases, this means you may experience a longer wait time and greater out-of-pocket costs.
- ER providers stabilize patients who are having emergencies and then either admit them to the hospital or refer them for follow-up care with their PCP.
- The benefit of an ER is that they are often established within a hospital or hospital system with ready access to specialized doctors and surgical care when needed.
You can save time and money by choosing the best place to go when an illness or injury happens. Watch this short video to learn more.