To Go to the Emergency Room or Not

June 29, 2009

Steps to take when you are in need of an Emergency room

Making a visit to the emergency room can be an expensive ordeal. Make sure you know what symptoms qualify you to visit a doctor, urgent care center, or the ER.

It’s important to know the most effective way to access care when you need it.

Is it an emergency?

“Approximately one-third of all emergency room visits are for non-emergency problems,” says Steve Lee, M.D., chief medical officer for Humana Senior Products in Florida. “It can be a costly and time-consuming way to access care.” On average, the cost of an entire ER visit exceeds $800.

So what is the best course of action when it comes to getting the doctor care you need when you need it?

What’s the best resource?

"Your primary care physician (PCP) is most knowledgeable and helpful when it comes to the coordination of your care,” explains Lee. “It’s very important to have a single doctor’s office that’s in the know and at the center of your healthcare."

A PCP provides your regular preventive care and screenings and works with any specialists to coordinate additional care. “Over time, they get to know you and can anticipate your health concerns,” says Lee.Some have physician assistants and advanced registered nurse practitioners as part of their practice. During those times when the PCP is unavailable, these people support the practice. “You shouldn’t be concerned if you’re directed to them, as they can provide quality care, write prescriptions, and usually work directly with your PCP to meet your overall healthcare needs,” says Lee. "Think of it as a team approach to your care."

Know Your Numbers

Place of treatment

Avg. cost per visit only*

Emergency room

$800+

Urgent care center

$108

Doctor's office

$78

Retail Clinic

$55*

*excluding additional tests, procedures, or medications

Urgent Care Facilities

When it comes to after-hours care, urgent care facilities – or walk-in clinics – are cost-efficient alternatives to emergency rooms. "If your PCP is not on call for after-hours care, he or she will have a covering physician responding to your call," says Lee. "They can provide advice and let you know whether you should visit an urgent care facility or whether something can wait to be managed until the following office day."

Remember that emergency rooms are for treating life-threatening situations. Save these visits for things like broken bones, chest pain, or difficulty breathing. Consider an urgent care facility when you need to see a doctor and your PCP office is unavailable

What you should do

Whether you visit an urgent care facility or an emergency room, there are a few things you should always remember to do:

  • If time permits, call your PCP’s office first
  • Take your PCP’s name and telephone number, including fax number, with you
  • Take all your medications – or a copy of your latest medical records – with you
  • Call your PCP’s office the next business day so they can follow up
  • Ask for a copy of your complete medical record of the visit (all tests, lab results, and discharge recommendations) and take them with you the next time you see your PCP
  • If possible, ask a friend or family member to accompany you (especially important for visits to the emergency room)

Don't know which step to take? Call HumanaFirst®

If you have questions about symptoms you’re experiencing, the HumanaFirst 24-hour Nurse Advice Line is available – for free – to most Humana members. Nurses on the other end of the line can answer your questions, assess your symptoms, make referrals to emergency room or urgent care facilities, or help you find a PCP in your area.

Call 1-800-622-9529

24 hours a day, seven days a week

This information was originally published in the Summer 2009 HAO Magazine.

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