What’s the difference between Urgent Care and Emergency Room Services? Find out here.
We sincerely hope there are few times (if any) that you have to pay a visit to an Urgent Care Facility or the Emergency Room, but life is full of surprises. In those distressing times, it’s important to know when OneShare Health Members should probably book an appointment at your local Urgent Care and when you should make haste to the ER.
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What's the Difference Between Urgent Care and ER? Information for Members of OneShare Health Christian Health Share.
With a medical cost sharing plan, like a OneShare health insurance alternative and Christian health insurance alternative, the difference between ER and urgent care is important to ensuring your medical cost sharing. OneShare Christian healthshare ministries, like OneShare health insurance alternatives, are a health share that lets you share the cost of your medical bills in the ER or Urgent Care with other members of cost sharing ministries!
What is Urgent Care?
Since the 1970s, Urgent Care centers in the U.S. has focused on “the delivery of ambulatory care in a dedicated medical facility outside of a traditional emergency department.” These walk-in facilities provide unscheduled medical care for injuries or illnesses that require immediate care but that aren’t serious enough for an ER Visit. They are generally staffed by a physician, nurses, physician assistants, and medical assistants. Even more good news, statistics show that 90% of Urgent Care center patients wait no longer than 30 minutes to see a Provider!
What's the Difference Between Urgent Care and Emergency Room? Our Christian health insurance alternative specifies the difference between urgent care and emergency rooms
What does OneShare Health consider Urgent Care?
According to OneShare Health’s Program Guidelines, Urgent Care is defined as "Services provided by a licensed Urgent Care Facility for the diagnosis, treatment, or management of an Eligible Illness or Injury serious enough that a Member would seek care right away, but not so severe as to require Hospital Emergency Room care."
Fortunately, OneShare Members1 get to enjoy broad access to Urgent Care Facilities and other In Network Providers across the country thanks to our partnership with First Health® Network.
Please note that Urgent Care is not available on the OneShare Health Catastrophic Program, and not all services are Eligible for Sharing. Urgent Care is subject to Pre-Existing Limitations, and Waiting Periods may apply. This highlights the Classic and Complete Programs, please refer to your Membership Guidebook to see how your specific Program applies.
When should you go to an Urgent Care Facility?
Some common examples that call for an Urgent Care Visit2 include cold- and flu-like symptoms; sprains and strains; minor cuts, even ones that require stitches; nausea; signs of infection for example a urinary tract infection; minor burns; fever; dehydration and earaches. Some Urgent Care Facilities may also offer imaging, X-rays, and Lab Services on-site.
Please note, an ER Visit is only Eligible for Life-Threatening or Life-Altering conditions.
What is the ER for, and what type of services does an Emergency Room administer?
According to the OneShare Health Membership Guidebook, Emergency Room Services provide stabilization or initiation of treatment of a medical emergency for Life-Threatening or Life-Altering conditions; they are provided on an Outpatient basis at a Hospital.
OneShare Health defines a Life-Threatening or Life-Altering medical condition as follows:
A condition which, if not immediately in receipt of medical treatment, has a high likelihood of causing death or causing major irreversible bodily harm (including, for example, loss of arm, leg, hand or foot; loss of sight or hearing; paralysis, or loss of brain function). The following are key signs and symptoms of Life-Threatening Emergencies: respiratory distress or cessation of breathing; severe chest pains; shock; uncontrolled bleeding; choking; poisoning; prolonged unconsciousness; severe burns; any complaint or observation which indicates head or spinal cord injury. The following are examples of Life-Altering Emergencies: broken bones; visible bones; or dismemberment.
When should you go to the Emergency Room?
An Emergency Room Visit is appropriate3 if you or a loved one is experiencing any of the following: extreme chest pain or difficulty breathing; head injuries; seizures; severe cuts or burns; sudden dizziness or numbness; severe allergic reactions, and loss of vision.
In the event you or a loved one experiences a Life-Threatening or Life-Altering medical emergency, OneShare Health recommends that you receive treatment for the said condition in an Emergency Room Facility.
How does a OneShare Health Program share in Urgent Care vs Emergency Room?
With the Classic and Complete OneShare Health Programs, Urgent Care is more affordable than an Emergency Room Visit. Please note, Urgent Care is not available on the OneShare Health Catastrophic Program. Additionally, the ISA4 and Sharing Maximum5 amounts vary on select Tiers of the Classic and Complete Programs6. For example:
|Urgent Care||In/Out-of-Network: 2 Per Program Year; $20 Visit Fee per Visit|
|Emergency Room (ER)||In/Out-of-Network: $300 Visit Fee per Visit|
|Urgent Care||In Network: $75 Visit Fee per Visit|
|Out-of-Network: 70% Shared after ISA|
|Emergency Room||In Network: $150 Visit Fee per Visit|
|Out-of-Network: $300 Visit Fee per Visit|
Please Note: if the Member is at the Hospital for 24 hours or more, ER will be considered a Hospitalization, and the Visit Fee will apply to the Member’s ISA. For the Classic, Thrive, and Catastrophic Programs, Ambulance—land, air, water transportation—for medically necessary Emergency Services to the nearest Medical Facility, or medical transportation between Facilities; when medically necessary, are Eligible for Sharing after the Member’s ISA is met, up to a Maximum Sharing of $10,000 per Emergency Medical Event.
For the Complete Program, Ambulance Emergency Services to the nearest Medical Facility or medical transportation between Facilities, when medically necessary, are Eligible for Sharing, after the Member’s ISA is met, subject to In / Out-of-Network Sharing Percentages up to a Maximum Sharing of $10,000 per Emergency Medical Event.
For more answers to your frequently asked questions visit our Knowledge Base!
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What is a health sharing ministry, and is OneShare Health legit? Simple: With Membership Programs like our Complete Program, OneShare Health is on the move to provide affordable, comprehensive, and Faith-based health care to all of our brothers and sisters in Christ. Join our Complete Program today!
“For we are his workmanship, created in Christ Jesus for good works, which God prepared beforehand, that we should walk in them.”
Ephesians 2:10 (ESV)
1Urgent Care is Not Eligible for Sharing on the OneShare Health Catastrophic Program.
2Pre-Existing Conditions apply, and a Waiting Period may apply. Please refer to your specific Membership Guidebook for details.
3Pre-Existing Conditions may not be Eligible for Sharing in an Emergency Room Visit. Please refer to your specific Membership Guidebook for details.
4Individual Sharing Amount (ISA): The ISA is what the Member is responsible to meet before certain services are Eligible for Sharing. ISA applies per Program Year. Maximum three ISAs per family on the Complete Program only. The Physician Office Visit Fee does not apply to the ISA. Facility Fees for Emergency Care and Urgent Care do not apply to the ISA.
5Individual Sharing Maximum / Family Sharing Maximum: This is the amount that the Member agrees to share towards Eligible Expenses during the Program Year, after the ISA has been met. For a Member using an Out-of-Network Provider or Facility, the Maximum Reasonable Guideline is the allowed charge made for necessary medical services, drugs, procedures, supplies, or treatment generally furnished for cases of comparable severity and nature in the geographical area in which the services, drugs, procedures, supplies, or treatment are furnished. Out-of-Network Providers and Facilities may bill the Members for the difference between the billed charges and the Program’s allowed amount, which may result in increased Member Sharing Responsibility.
6Refer to Membership Guidebook for full details such as Waiting Periods, Pre-Existing Conditions, Limitations, and applicable ISA to all Sharing Services. Complete Program: Certain Limitations and exclusions apply, including for Pre-Existing Conditions, and may affect Eligibility for sharing. Unless stated otherwise in the Eligible Sharing Descriptions and Limits, there is a 90-Day Waiting Period for any medical expenses other than for accidents, injuries, acute illnesses or immunizations. Pre-Existing Condition Limitations and Program guidelines will apply. After the ISA is met and Out of Pocket Maximum is reached, Eligible Expenses are 100% Shared for the remainder of the Program Year, up to Maximum Limits. Visit Fees continue to apply after the ISA and Out of Pocket Maximum have been met. Classic, Catastrophic, and Thrive: Unless stated otherwise in the Eligible Sharing Descriptions and Limits, there is a 90-Day Waiting Period for any medical expenses other than for Accidents, Injuries, Acute Illnesses or Immunizations. Pre-Existing Condition Limitations and Program Guidelines will apply. Visit Fees continue to apply after the ISA is met.