Differences of Urgent Care and the Emergency Room

Urgent care clinic
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When a patient experiences pain in the chest, they are often unsure about where they should go. Should they call 911, go to the emergency room, visit an urgent care center, or try to see their primary care doctor? It's not always an easy decision.

Moreover, the cost of making the wrong decision can be significant, affecting either your pocketbook or your health.

Urgent vs. Emergency Care

Some conditions are considered absolute emergencies: heart attacks, strokes, sepsis, anaphylaxis, and gunshot wounds are just some of the medical conditions that are universally considered emergencies. They must be evaluated and treated in the emergency department.

If a patient goes to an urgent care center with a true medical emergency, the urgent care staff should send them to the emergency department anyway, often by ambulance and often at a substantial cost.

That's just a small sample of what constitutes an emergency. The list is a lot longer and it always includes a diagnosis. In other words, one almost has to know they're having a heart attack in order for it to be a real emergency.

It is ultimately the responsibility of the emergency department to determine whether the symptoms you are experiencing are an emergency. The American College of Emergency Physicians ((ACEP) concurs but many health insurers don't.

If the ER doctor reviews your symptoms and refers you to an urgent care center, you could be responsible for the entire cost of the visit even if your symptoms were suggestive of a life-threatening event.

Urgent Care Centers

One might hear the term "urgent care center" and assume that "urgent" means this is a place where serious medical conditions can be treated in a similar, if not identical, manner to an emergency department. The truth is that "urgent" is defined differently in every state.

Some states consider urgent care centers nothing more than glorified physician offices. Other states treat them like stand-alone emergency departments as opposed to hospital-based ones.

Urgent care centers might be staffed with physicians or only with nurse practitioners or physician's assistants, depending on state law. As state legislatures address the needs of their populations, the rules change quickly.

With such diverse regulations, going to an urgent care center for a medical emergency is a gamble unless you are clear about what the center can or cannot treat.

In most cases, people should treat an urgent care center as they would a doctor's office, albeit with longer, more flexible hours and walk-in availability.

Cost and Coverage

The whole concept of urgent care centers was born out of runaway healthcare costs. Folks regularly go to the ER when they could've gone to their private doctor for substantially less cost.

Compare the bills for an emergency department and an urgent care center side by side, and you'll see that urgent care centers are almost always substantially less expensive when the medical condition is something they can treat. That doesn't mean that it is always cheaper to go to an urgent care center.

Depending on the terms of your insurance policy, you may have to choose between in-network centers (those that have negotiated rates with your insurer) and out-of-network centers (those that haven't). In most cases, urgent care centers that are out-of-network will not be covered by your health insurance. Even if they are, the copay/coinsurance costs will almost invariably be high.

If an urgent care center is not in-network, but an emergency department is, it could end up costing you less to visit the ER.

With that said, if the ER visit is not deemed necessary by your insurer, you could still be left footing the bill even if the facility was in-network.

Avoiding Claim Denials

To better deal with insurance mishaps and denials, some emergency departments have urgent care centers built within them. Based on the initial diagnostic review by a triage nurse, you would be forwarded to the appropriate center for your treatment.

Many insurance companies will use hospital admission as a litmus test to determine if you were truly sick enough to need emergency care. If you were admitted to the hospital after the ER visit, your insurer might reduce or waive co-pay or out-of-pocket deductible costs. On the other hand, if you are not admitted, you will likely be on the hook for the entire deductible or co-pay.

Insurers will use these sort of sliding-scale payments as a disincentive for choosing the ER for first-line medical care. Many patients, however, don't have a choice. Their doctor may not be available for a same-day visit. Similarly, many urgent care centers are not open 24 hours a day.

Even if you advise your insurance company that had no other choice but to visit an ER, they will often ignore you until a more formal complaint or review is lodged.

Freestanding Emergency Rooms

A freestanding or stand-alone ER is a relatively new invention cropping up all over the country. Currently, around 35 states allow for these freestanding emergency centers. Some aren't emergency departments per se, because they are independent and unassociated with a hospital. In some states, physicians are permitted to own and operate ER facilities.

Stand-alone emergency centers might look very similar to an urgent care center. They often operate in the same places, such as malls and retail districts. They won't be adjacent to a hospital—at least not in the same building—and they may or may not have an ambulance entrance.

Most of these facilities advertise a full range of services, including a paid ambulance service to rush you to a hospital if needed.

While beneficial to those who don't have a nearby hospital, freestanding ER rooms may be inappropriate for people with life-threatening events, like a heart attack or stroke, who can be treated more expeditiously in a hospital.

A Word From Verywell

The emergency department is the definitive immediate-need healthcare option. This is the place patients can go for any sort of medical condition, regardless of how severe or benign it may be. Emergency departments are also the most expensive option.

An ER visit bill will almost always in excess of $1,000 even if all you need is an aspirin. A trip to the urgent care center or to a doctor's office, on the other hand, is likely to be two or three hundred dollars for the exact same care.

It's important to understand the differences—and what conditions they are better suited to treat—so that you won't end up with bills you cannot pay.

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Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • Fact Sheets. (2017). American College of Emergency Physicians | News Room.

  • You thought it was an urgent care center, until you got the bill. (2017). NBC News.