Know where to go when you need care

When you or someone you love is sick or injured, where do you go for care? Your doctor’s office? The urgent care clinic? Or the emergency room? Sometimes, it’s hard to know what’s best. Here is a breakdown of your options.    

1. The doctor’s office
   • Earaches
   • Sore throats
   • Fevers that respond to fever-reducing medications
   • Ankle sprains and other strains of muscles and joints
   • Coughs and colds
   • Abdominal pain or other symptoms that resemble an illness that is “going around”

Your personal doctor should be your first call in most non-emergency situations. Your doctor knows you and your health history, including what medications you are taking and what chronic conditions might need to be considered in your treatment. Here are a few things to know about your doctor’s office:

• Most primary care doctors are available by appointment only.
• Visits are typically in-person.
• Costs vary but are usually lower than urgent care and are much lower than the cost of emergency care.
• Long wait times can typically be avoided by going to your doctor.

When to go to your doctor’s office:

• Routine checkups, preventive exams, tests and immunizations
• Concerns about chronic issues
• Injuries or illnesses that are not life-threatening, and can wait for a doctor’s office visit, such as:

If your doctor isn’t available, you may be able see another doctor who is part of the clinic or practice where you have established care. If you don’t have a personal doctor, search for one with the Find a Doctor/Hospital tool.  

2. Virtual care

Virtual care, also known as telehealth, is a way to receive non-emergency care from a board-certified doctor from your phone, tablet or computer. Here are a few things to know about using virtual care:

• Blue Cross members have access to virtual care through Amwell®, 24 hours a day, 7 days a week.
• Virtual care visits, whether with your primary doctor or through Amwell, are covered the same as an in-person visit through your health insurance plan. Once you are registered or signed in to Amwell, you’ll typically receive care within minutes.
• When necessary, you can get a prescription from a virtual care doctor.

When to use virtual care:

• When you don’t have transportation, or your work or family schedule makes it hard for you to get to the doctor’s office.
• When you don’t feel well enough to travel to a doctor’s office, but you need non-emergency medical attention.
• When your doctor isn’t available.
• When you’re away from home.
• Virtual care can be particularly helpful for illnesses such as:
• Cold/flu
• Fever
• Rash
• Sinus or ear infection
• Pink eye

Virtual care isn’t meant to replace care from your personal doctor. It is meant to help fill in gaps in care when you are unable to see your doctor.

3. Urgent care

Urgent care clinics, also known as walk-in clinics, provide care without an appointment for injuries and illnesses. Urgent care is the best choice when you need care quickly, but it’s not an emergency, and your personal doctor is unavailable. Here are a few things to know about urgent care:

• Each urgent care clinic has its own operating hours, so be sure to check before you go.
• Typically, you will pay more for urgent care than a doctor’s office or a virtual care visit. Urgent care costs far less than emergency room care.
• Longer wait times are common in urgent care centers.

When to seek urgent care:

• If you can’t wait for a doctor’s appointment, if your doctor’s office isn’t open or your illness isn’t suitable for a virtual care visit.
• For injuries or illnesses that are not life-threatening, but can’t wait for a doctor’s office visit, such as:
• Sprains and strains
• Minor broken bones
• Minor cuts, scrapes and burns
• Flu and fever (below 104°)
• Earaches or sore throats

4. Emergency room

The emergency room is a hospital facility staffed 24 hours a day, 7 days a week, to provide care for life-threatening conditions requiring immediate care. In an emergency, it’s important to act quickly by calling 911 or going directly to the emergency room. Here are a few things to know about emergency rooms:

• It costs much more to receive care in an emergency room, compared to an urgent care center, virtual care or a doctor’s office.
• face the longest wait times in emergency care rooms, if you go there for a situation that does not require immediate attention.

 When to go to the emergency room:

• Call 911 or go to the emergency room for life-threatening situations where you feel like a delay in care (even if it’s only a few hours) could negatively impact your health.
• For severe or life-threatening symptoms that require emergency care, such as:
• Severe head injuries or broken bones
• Chest pain or shortness of breath
• Excessive bleeding or extreme pain
• Sudden blurred or lost vision

 For a complete list of emergency situations, visit ACEP.org.

The emergency room can save your life if you’re seriously sick or injured. But for less severe health issues, you will get faster and less expensive treatment elsewhere. Instead, call your personal doctor, seek virtual care, or go to an urgent care center.

How much will it cost?

Download our brochure on healthcare vs. cost

Want more information? Sign in to Blue Access for your personalized health plan benefits, and to find out how much your cost share* is for doctor’s visits, virtual care, urgent care and emergency room visits. You can also search for providers, get claims information and find answers to common questions you may have about your health plan.   * Cost sharing definition: Your share of costs for services that a plan covers that you must pay out of your own pocket (sometimes called “out-of-pocket costs”). Some examples of cost sharing are copayments, deductibles and coinsurance. Family cost sharing is the share of cost for deductibles and out-of-pocket costs you and your spouse and/or child(ren) must pay out of your own pocket. Other costs, including your premiums, penalties you may have to pay, or the cost of care a plan doesn’t cover usually aren’t considered cost sharing.