How To Understand The Difference Between Health Care Clinics

Chances are, you won’t drive far across North Dallas without coming across a healthcare clinic in your area. They may seem alike in appearance and convenience, but the untold distinction lies in what you’ll end up paying for their services.

Knowing the difference in how these clinics are set up and staffed can have a serious effect on your ability to save money on healthcare costs. The lack of public education, coupled with massive growth in private healthcare facilities, creates confusion when patients are forced to make a quick decision on their healthcare needs.

There are three basic types of healthcare clinics, so let’s start with how each of them are defined, along with their billing structure:

Emergency Rooms (ER)

Freestanding and hospital-based emergency rooms only have one level of billing, an expensive ER-level model that charges emergency room prices regardless of the severity of your case. ERs are a health facility open 24 hours a day 365 days a year and staffed by board certified physicians to treat emergency conditions. Patients are billed the emergency room copay designated by the insurance plan they have. Patients may also be required to pre-pay a deductible designated by the insurance provider.

Urgent Care Centers

Urgent Care centers are walk-in clinics that focus on treating non-life threatening illnesses that require immediate care but aren’t typically serious enough for an ER visit. Most, but not all, urgent care clinics are staffed by a physician, physician assistants, advance practice clinicians, and nurse practitioners who work independent shifts. These clinics are not required to have a licensed physician on staff. Normal office copays are designated by the insurance provider.

Hybrid Care Facilities

Hybrid care facilities offer ER and urgent care services under one roof and take a different approach to healthcare. At hybrid care facilities, patients meet with board-certified and ER-licensed physicians who review their health issue and determine if they need to be treated as an ER patient or as an urgent care patient. Patients are billed accordingly, allowing them to pay only for the level of care they need.

Why It Matter$

It’s important for consumers to understand that they can get their injuries and illnesses treated at a much lower cost at a hybrid care or urgent care facility. This is because a significant number of all ER episodes – 44% to 65% – are actually urgent care treatable. Meaning the injury or illness isn’t serious enough to require an ER visit. On average, urgent care cases cost approximately $226, while that exact same case treated at an ER or a freestanding ER will cost approximately $2,039 – a hefty difference, especially if the case doesn’t actually require an ER visit.

By understanding your options of healthcare facilities other than a freestanding or hospital-based ER, consumers can reduce their medical costs and save themselves thousands of dollars on out-of-pocket costs, premiums, and deductibles.

Hybrid care models allow medical staff to be more efficient, more cost-effective, and more focused on the patient. This unique approach could be the difference between a patient paying a small copay (urgent care) or a high deductible (ER) for the same services at a traditional emergency room, where you are billed for ER services regardless of the cause.

For the sake of people’s budgets, it’s important to recognize that unless your healthcare need is an absolute emergency, visiting a strict urgent care facility offers a better alternative, cost-wise. It can mean a difference in billing of $1,813.

authored by Dr. Jay Woody, Frisco resident and co-founder of Legacy ER & Urgent Care, which has six North Texas locations, including Frisco: 16151 Eldorado Parkway, Frisco, Texas 75035: Phone: (972) 731-5151.