How to Choose a Medical Facility in an Emergency
*Disclaimer: The information provided here is not professional medical advice. I am not a diagnostic medical professional, nor am I your diagnostic medical professional. This is for informational purposes only. Seek the advice of a diagnostic medical professional for all medical matters.
Mom was having excruciating pain in her abdomen.
We didn’t know what was causing the pain, but we knew she needed to see a medical professional immediately.
Should we call her family doctor? Try the urgent care? Or go straight to the emergency room? Maybe we should use the nurse call line to ask for advice.
Should I be thinking about insurance now?
Factors to Decide What Medical Facility to Choose
There are many factors that determine the best medical facility to match with a particular medical situation.
In the paper “Many Emergency Department Visits Could Be Managed At Urgent Care Centers And Retail Clinics” published in Health Affairs, the authors Weinick, Burns, and Mehrotra determine that “There is some evidence that patients can appropriately self-triage to these alternative sites.”
That’s good to know because sometimes, self-triage (deciding what medical facility to go to based on symptoms and facility availability) is often left up to the patient or their family.
1. Evaluate the Situation
Here’s a handy evaluation tool:
First: Decide how serious the situation really is. Try to set anxiety and fear aside and look at the facts before you. If little Johnny is up and playing like a beast, chances are the situation is not critical. If Aunt Sally having trouble breathing, time is of the essence.
Second: Think about the day of the week and time of day. Is it 3 am on a Sunday morning? If so, your medical facility choices will be more limited than at noon on a Wednesday.
Third: How far away are you from treatment facilities? Do you live next door to an urgent care?
Use common sense. Evaluate the problem to the best of your ability, consider the options, and choose the best fit. When in doubt, choose the emergency room if it’s available.
2. What Facility Best Matches the Patient’s Needs?
You’ve done a quick evaluation of symptoms. You know what facilities are most likely to be open that day and time and which locations are most convenient from where you are. Now take that information and match it with the appropriate medical facility.
Here’s a quick, general guide to help decide:
Primary Care Doctor’s Office – Non-Emergency care
Urgent Care / Retail Health Clinic – Escalate to urgent care or retail health clinic if the primary doctor is unavailable.
Emergency – Emergency room or call 911.
Still not sure? If it’s not an emergency, call your health insurance’s 24-hour nurse line for a consultation (where available).
The Ohio State University Wexner Medical Center shares lists of medical conditions and appropriate treatment facilities that can help guide your decision.
It can be hard to stay calm, but do your best.
3. Do You Have Health Insurance?
In a perfect world, “Do you have health insurance?” would not be a question we even need to consider. But here we are.
Get the care you need regardless of your insurance status, but if the situation allows time, making certain decisions could save major dollars down the road. The best time to do your research is BEFORE a medical crisis arises.
Ever heard of The Prudent Layperson Standard? According to www.emergencyphysicians.org, “The Prudent Layperson Standard is a part of federal law that provides an important patient protection and functions as one of emergency medicine’s bedrock principles, alongside the Emergency Medical Treatment and Labor Act (EMTALA), which ensures that anyone can receive emergency care regardless of insurance status or ability to pay.”
While this sounds like you can go immediately to the emergency room, keep in mind that insurance companies may DENY claims from emergency room visits that are not considered critical by laypersons (that’s you and me). If you go to the emergency room to get your routine vaccinations – there’s a good chance your insurance will refuse to pay.
Generally speaking, emergency rooms and hospitals are the most expensive healthcare available. If you are having an emergency, by all means, go directly to the ER. But if you have a sprained ankle and need an x-ray, consider visiting an urgent care first.
The Consumer Financial Protection Bureau states “Some people are pushed into bankruptcy by medical bills that they cannot pay.” In fact, a Harvard Law professor “concluded that “62.1% of all bankruptcies have a medical cause.”
Understand your health insurance benefits BEFORE you need them. How much is an emergency room visit versus a trip to the urgent care? Does insurance cover the cost of an ambulance?
Discuss your preferences with your family when it’s NOT an emergency.
If in doubt, you may decide to go to the emergency room.
Conclusion
When Mom was sick, we ended up at the emergency room 3 miles away from her house. Her doctor was an hour away and the urgent care wasn’t yet open for the day. We gathered the information available, considered the sudden onset of her mysterious pain, and evaluated facility options.
Since I’m a board certified patient advocate, I had the tools and expertise to know how to decide. We made the right choice for my mom.
I’d love to hear if you have any specific questions about advocacy. Contact me at support@patientadvocateinfo.com to let me know what’s on your mind.
Free Resources
Need more information? Download the FREE The Essential Guide to Legal Documents for Everybody to learn what documents you may need to support your loved one.
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