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California Health Insurance - Urgent Care - Emergency Room, Which one should you use and when?

Not the Same Thing When It Comes to California Health Insurance

MattsInsurance4CA would like to help California health insurance policy holders distinguish the difference between Emergency Room care and an Urgent Care visit.  When it comes to California health insurance, the specific definitions of each can make a huge difference when it comes to coverage, benefits, and out-of-pocket expenses. California Health insurance companies want their policy holders to get to know the difference, understand what types of services are covered, and how to make sure benefits are accessed. That’s why it’s so important to read and understand the terms of a California health insurance plan.

Urgent care centers are available in a wide range of communities and may be accessed by individuals 24 hours a day, much like emergency rooms in hospitals. However, services provided in an urgent care center and an emergency room setting is vastly different.  Knowing the difference can save your life.

California Health Insurance and Emergency Room Care

Emergency room care is generally defined as services focused on treating unexpected or sudden illness or injury that may cause loss of life. Traumatic injuries, fractures, loss of a limb, loss of site in one or both eyes, as well as situations that may create long-term medical complications if not treated immediately fall under the emergency care category. A few examples of situations that demand emergency room benefitsinclude but are not limited to:

  • Unconsciousness
  • Uncontrollable bleeding
  • Chest pain
  • Numbness or paralysis of an extremity
  • Suspected poisoning
  • Suspected drug or medication overdose
  • Severe shortness of breath or inability to breathe
  • Second or third degree burns
  • Sudden slurring speech
  • Lack of responsiveness
Such situation requires immediate attention and care. Obtain medical attention by calling 911, driving, if possible, to the nearest emergency room, or calling your physician. In most cases, physicians are available 24 hours a day, and their after-hours call services will alert the physician in emergency situations in order to advise patients on a course of action.

Urgent Care and California Health Insurance

Urgent care is defined by California health insurance companies as a situation that may require prompt medical attention and treatment, but not one that may cause imminent medical complications or death. For example, situations that are commonly dealt with in an urgent care center setting include but are not limited to:

  • Urinary tract infections
  • Minor or first-degree burns
  • Ear infections
  • High fevers
  • Muscle sprains and strains
  • Prolonged bouts of diarrhea
  • Prolonged bouts or excessive vomiting

Most urgent care visits occur during the evening hours or on weekends or holidays when doctors are not normally in their offices. However, if you are ever in doubt as to the level of care that may be necessary, err on the side of caution and visit your local emergency room.

Different California health insurance carriers offer different payment benefits when it comes to emergency room or urgent care services. Always check your policy to make sure you know what is covered and what is not in each of these scenarios. However, it's essential that individuals receive the care that it's necessary. Don't put off a trip to the emergency room thinking the visit may not be covered. Most hospitals and urgent care centers are willing to work with patients with payment terms and obligations.

If you’re looking for a California health insurance plan that covers both Urgent Care and Emergency room benefits you can find one here. Get an instant California health insurance quote by following the link above. Our quoting tool will show you all the top rated California health insurance carriers and all the plans they have to offer in your area. Matts Health Insurance Services is an independent broker and an authorized agent with California health insurance companies like Anthem Blue Cross, Blue Shield of California, Aetna Health Plans, Kaiser Permanente, Health Net, PacifiCare, United Health Care, and Celtic Health Plans. Be sure to review the benefit details to see how Urgent Care and Emergency Room benefits are covered. Once you see a plan you like you can apply for coverage online with our California health insurance carrier direct secure applications or you can print out an application and fill one out by hand. Regardless of how you apply, it’s important to get a health plan in force and to keep it. Don’t get caught uninsured.

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