Health Insurance Articles
Why HMOs Often Recommend Urgent Care Over Emergency Care
2011-09-14
Urgent care is encouraged by most HMO providers since you can get comprehensive services apart from the basics that an HMO plan provides. If you have an urgent need for health care services, you can go to a center that provides immediate care. Other services can also be obtain from these centers and treatment for minor injuries such as bruises, sprains and strains can also be provided. There is always urgent care readily available the moment the situation calls for it. Most HMO providers recommend urgent care the moment a situation arises. This will prevent any situation from worsening.
On the other hand, if you have a more serious condition, such as chest pain, severe bleeding or head trauma, you should seek emergency care. If the condition is life threatening, you are more likely to be brought to a hospital emergency room than an immediate care facility. If you are brought to an immediate care center, you will still be directed to take emergency care services. If you have an existing HMO plan, is a good idea to make sure your plan includes emergency care. This will ensure that you have the option to be covered for treatment in case of a more serious injury.
If an HMO doctor is unavailable or the in-network clinic is closed, an out-of-network immediate care or emergency center can be used, but you likely won't be reimbursed by your HMO unless the care is absolutely essential. You will get treated, but in the event that the doctor indicated in your HMO plan is not around and your condition is not extremely serious, you will pay for it 100% out of pocket. You will feel better, but you will also pay for the privilege. Everyone should acquire emergency care coverage, since an HMO plan only provides basic medical assistance in urgent care facilities, unless you can justify using emergency services. Basically, an HMO only covers treatment for less serious cases and true emergencies unless you purchase additional immediate or emergency care services.
For obvious reasons, you should only go to the emergency room for serious cases, such as severe cases of trauma. The moment you enter an emergency room facility, you are covered by the insurance policy you have, assuming your plan includes emergency care coverage. On the other hand, if you go to the emergency room for a less serious case, such as minor cuts and burns, you will not be covered by the HMO plan you have. In other words, it is better to take the services of an urgent care facility for administering medical treatment for less serious cases than paying for emergency room service for minor injuries.
