When should you use primary care, urgent care centers, or the emergency room?

by / Friday, 04 September 2015 / Published in Health Insurance

When you or a family member gets sick or hurt, you want a doctor — and fast. But depending on the severity of the medical issue, pausing for a moment and thinking about not just the closest place to get care, but the most appropriate place to get it, can make a big difference.

A National Health Interview Survey found that almost 80 percent of adults who visited ERs over a 12-month period said they did so because of a lack of access to other health care providers. In fact between 13.7 percent and 27.1 percent of all emergency room visits are non-urgent, according to a 2010 Health Affairs study.

So, how do you know when to use your primary care physician vs. an urgent care center or an emergency room? Keep on reading to learn more about the most appropriate site for services based on the type of care needed.

What is a primary care physician (PCP) or family doctor?

A PCP is a doctor you select to be your general source for addressing your regular health care needs. Your go-to doctor, they know your history and can typically coordinate your in-depth health care services with specialists if or when you need one.

Your PCP is the first one you should contact when you need care. PCPs often leave time in their schedule for “sick visits,” and can see you same day for minor illnesses or injuries. If the symptoms you share when making your appointment warrant immediate care, your PCP may suggest you instead visit an urgent care center or emergency room.

What is an urgent care center?

An urgent care center is a medical facility that employs board-certified doctors for the treatment of cuts, sprains, sinus infections, nausea, and other types of less serious medical conditions. You don’t need an appointment to visit an urgent care center and they often have night and weekend hours.

Always call your primary care physician first when you need medical care. If you need care at night or during the weekends when your primary care physician is unavailable, then you can visit an urgent care center for non-emergency health care needs. Just show your Independence Blue Cross member ID card at a participating urgent care center and your visit is covered at a cost less than it would at an emergency facility.

Urgent care is not emergency care – Know the difference. In case of an emergency, or if you are unsure if you can drive to the nearest emergency room, you should call 9-1-1.

A visit to an urgent care facility or your primary care physician is recommended if you experience:

  • Allergic reaction
  • Asthma attack (minor)
  • Bronchitis
  • Colds, cough, flu, fever
  • Dehydration
  • Dizziness
  • Ear infection
  • Insect bite
  • Migraine
  • Minor burns
  • Minor cuts/lacerations
  • Minor head injury
  • Nausea
  • Pink eye
  • Rash
  • Sore throat
  • Sprain or strain
  • Urinary tract infection

What is emergency care?

Seek treatment at a hospital emergency room for life-threatening medical situations. You should visit the closest emergency room or emergency facility if you experience one of the following symptoms:

  • Chest pain
  • Broken bone
  • Fainting
  • High fever
  • Ingestion of obstructive object
  • Major head injury
  • Palpitations
  • Pneumonia
  • Seizures
  • Severe abdominal pain
  • Severe asthma attack
  • Severe burns
  • Severe headache
  • Shock
  • Shortness of breath
  • Unconsciousness
  • Uncontrollable bleeding

To summarize:

  • If it is not a true emergency, try to contact your primary care physician. This is the most affordable cost-sharing option.
  • If it is not an emergency and your PCP is not available, try an in-network urgent care center. This option is still more affordable from a cost-sharing perspective and helps you to avoid the longer wait times in the emergency room.
  • In case of an emergency, go to the nearest emergency room. If you are unsure if you can get there on your own, call 911.

Additional Resources

As SVP and Chief Marketing Executive at Independence Blue Cross, Paula Sunshine is accountable for the Individual Under-65 market segment. In this capacity, she is directly responsible for developing and executing all direct-to-consumer marketing and sales capabilities. In addition, Ms. Sunshine is accountable for insuring the delivery of market-competitive products and pricing as well as operational readiness for the Consumer market.

12 Responses to “When should you use primary care, urgent care centers, or the emergency room?”

  1. Thank you for posting such an informative article It reassuring to get a better understanding on the time and place for urgent care and the importance of both. This clears up a lot of grey lines! http://www.myfloridaurology.com

  2. We constintly get asked “Insurance” questions at Harris Dermatology that has nothing to do with Dermatology and more to do with their insurance carrier. It is helpful to read articles like this when asked about ER visits. This is a great article for any healthcare provider. Thank you for the education. William Lees – Harris Dermatology Marketing

    • avatar IBX Insights Team says : Reply

      Hi William. Thank you for your comment. We are glad you found this information to be helpful! Sincerely, Daina H.

  3. avatar Ben Allen says : Reply

    I appreciate the information on the differences between primary care and urgent.I agree that sometimes it is hard to tell whether or not you will need a primary care physician or an emergency care. My sister wants to be more prepared for any future emergencies, I will be sure to share this with her.

  4. avatar Alex Dean says : Reply

    As my dad is getting older, he is experiencing more and more medical issues. Being his daughter I want to make sure he is getting the right help he needs, but I would like to know when to take him to urgent care or if I am safe to take him to his regular doctor. It’s good to know that if I am not sure about a medical issue then I should call his primary care giver, unless it is a weekend or at night then it is okay to visit an urgent care. This really does help narrow down what I should do in any given situation when it comes to my dad’s health. Thanks for the information!

  5. Thank you for talking about how you can get nonemergency treatment at urgent care clinics. It makes sense that understanding your options and choosing the best for your case can help you get the right treatment. I can see how anyone looking for good health care would want to do their research beforehand and make sure they find a clinic that has a good reputation and the best doctors.

    • avatar IBX Insights Team says : Reply

      John, thank you for your feedback! We are happy you liked the topic. Please feel free to mention other topics you’d like to see covered. Sincerely, Stephanie K.

  6. avatar LNWeaver says : Reply

    That’s a good tip to visit an urgent care when your PCP isn’t in. My daughter plays soccer so she’s prone to injury at odd times. I’ll have to find an urgent care we can visit if she rolls an ankle or something at a night or weekend game.

  7. avatar Amy Tang says : Reply

    This is a great post and it was nice for me to read it. I really appreciate the insight here in this post and confident it’s going to be helpful to me and many others. Thanks for your share

  8. While vital care centers have an important part to play in your health, they’re not a substitute for a regular doctor. Although they offer comprehensive medical treatment for a wide variety of injuries and illnesses, they can’t replace the relationship you have built up with your family doctor or primary care physician. Instead, think of urgent care centers as a convenient option when your doctor is unavailable, unable to make a timely appointment, or when you require medical attention for an acute, but not necessarily life-threatening emergency.

  9. Thanks for the information on how urgent care centers have certified doctors that can treat your less serious medical conditions. This would be a great way to get qualified care quickly and efficiently. When choosing a center, you’d probably want to look them up before you have a problem so you can make sure you know the best one in your area and are prepared in order to get there as soon as possible when you have an issue.

Leave a Reply