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Why is My Copay Higher for Urgent Care Centers?

Key Points

  • Urgent care facilities have a higher overhead than most primary care physicians, so the overall cost is going to be higher in urgent care. However, their costs are much lower than an emergency room.
  • An NIH studied the costs of emergency departments and urgent care centers in Texas and found that prices in 2015 for an emergency department were over $2,000 per visit, while an urgent care was only around $165 per visit.

Urgent care centers can be a huge help when you or a family member needs immediate care for an illness or injury. However, you often discover afterward that your copay is higher than you expected.

Urgent care facilities have a higher overhead than most primary care physicians. On top of that, insurance companies feel that, in general, the overall cost is going to be higher in urgent care.

Why do insurance companies charge more for urgent care when compared to regular doctor visits? Let’s take a look at some of the most common reasons.

Why is My Copay Higher for Urgent Care Centers?

Key Points

  • Urgent care facilities have a higher overhead than most primary care physicians, so the overall cost is going to be higher in urgent care. However, their costs are much lower than an emergency room.
  • An NIH studied the costs of emergency departments and urgent care centers in Texas and found that prices in 2015 for an emergency department were over $2,000 per visit, while an urgent care was only around $165 per visit.

Urgent care centers can be a huge help when you or a family member needs immediate care for an illness or injury. However, you often discover afterward that your copay is higher than you expected.

Urgent care facilities have a higher overhead than most primary care physicians. On top of that, insurance companies feel that, in general, the overall cost is going to be higher in urgent care.

Why do insurance companies charge more for urgent care when compared to regular doctor visits? Let’s take a look at some of the most common reasons.

Cost compared to primary care physician

Most insurance companies charge a higher copay for going to an urgent care facility than if you go to a primary care physician. There are a few reasons for this. First, urgent care centers generally have a higher overhead cost than traditional clinics. While they are not dealing with life-threatening issues like an emergency room, they do have to plan and staff for the unexpected.

While a doctor’s office may know in advance when they, for example, need an EKG, an urgent care may need one immediately without notice. Because of this, a doctor’s office can schedule around having only one EKG machine, whereas an urgent care clinic may need more and cannot afford to have them temporarily unavailable.

While most medical offices take appointments and can plan their schedules accordingly, urgent care centers are always “on.” Additionally, these facilities have to do a lot in the way of diagnostics. All this gets expensive, which means going to an urgent care will cost more than simply going to your family doctor. On top of that, many insurance companies choose their copays based on the estimated cost of a visit.

Because urgent care will be treating you on an urgent basis, the care will likely cost more than a routine checkup with a primary care physician. This is one of the biggest factors in a higher copay for urgent care. As a result, most health plans offer urgent care copays ranging from $35-75 per visit, while primary care copays range from $20-50.

Cost compared to the emergency room

Though urgent care is more expensive than visiting a primary care physician, it's important to note that it is cheaper than going to the emergency room.

The NIH studied the costs of emergency departments and urgent care centers in Texas and found that prices in 2015 for an emergency department were over $2,000 per visit, while an urgent care was only around $165 per visit.

It’s a big difference. So why are emergency departments so much more expensive?

This is because the emergency room has a much larger overhead. They need to staff more robustly, including specialists, surgeons, nurses, and house, and maintain specialized equipment for life-threatening diagnosis and treatment.

Not only is the copay for visiting urgent care lower than visiting the emergency room, the overall cost of diagnostics and procedures is also lower. Because of the lower cost, if it is possible to visit urgent care, it is suggested in most cases.

However, remember that urgent care is not appropriate for life-threatening conditions. If facing a life-threatening health emergency, don’t hesitate to contact an appropriate emergency department. They will have the medical care and specialists necessary to help you more effectively than an urgent care center.

However, if you have something that needs to be treated right away but isn’t life-threatening, urgent care can save you a lot of money over the emergency room. Examples of issues that can get treated at urgent care include flu, strep throat, sprained joints, possible broken bones, digestive issues, and more.

Overall cost

The overall cost of visiting an urgent care facility will vary depending on the condition treated. On top of this, it will depend on whether or not you have insurance, the insurance provider, and specific plan you are a member of.

Many urgent care centers start with a base rate for the visit and then add specific services that you need, including tests, imaging, and specific treatment.

How to save money on urgent care

While an urgent care clinic does have a higher copay amount than a regular doctor, the cost is less than if you went to an emergency room. So it is a good option if you need immediate but non-emergency care.

The best way to save money is to plan your visits as much in advance as possible. If you need a COVID vaccine or a flu shot, you can schedule those with your normal doctor.

You can also look at self-pay options, which may be less expensive than you expect. With Solv, you can clearly see what the price is and know exactly what to expect. You deserve to be in control of your financial and physical health. Take a look at Solv ClearPriceTM today!

Sources

Solv has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

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