What’s the difference between Urgent Care and ER 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 is Urgent Care?
Since the 1970s, Urgent Care 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 patients wait no longer than 30 minutes to see a Provider!
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 Members* 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.
*Urgent Care is Not Eligible for Sharing on the OneShare Health Catastrophic Program.
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 Visit* 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.
*Pre-Existing Conditions apply, and a Waiting Period may apply. Please refer to your specific Membership Guidebook for details.
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 is an Emergency Room Visit the best course of action:
An Emergency Room Visit is appropriate* 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.
*Pre-Existing Conditions may not be Eligible for Sharing in an Emergency Room Visit. Please refer to your specific Membership Guidebook for details.
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 said condition in an Emergency Room Facility.
How does a OneShare Health Program share in Urgent Care Visits versus an Emergency Visit?
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 ISA* and Sharing Maximum** amounts vary on select Tiers of the Classic and Complete Programs***. 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.
*Individual 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.
**Individual 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.
***Refer to Membership Guidebook for full details such as Waiting Periods, Pre-Existing Conditions, Limitations, and applicable ISA to all Sharing Services.
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“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)
ONESHARE HEALTH, LLC (ONESHARE) IS NOT AN INSURANCE COMPANY BUT A RELIGIOUS HEALTH CARE SHARING MINISTRY (HCSM) THAT FACILITATES THE SHARING OF MEDICAL EXPENSES AMONG MEMBERS. As with all HCSMs under 26 USC § 5000A(d)(2)(B)(ii), OneShare’s members are exempt from the ACA individual mandate. OneShare does not assume any legal risk or obligation for payment of member medical expenses. Neither OneShare nor its members guarantee or promise that medical bills will be paid or shared by the membership. Available nationwide, but please check https://www.onesharehealth.com/legal-notices for the most up to date state availability listing.
Enrollment in OneShare is not a contract for insurance. Participation in OneShare is voluntary. Enrollment as a OneShare member is voluntary, and the sharing of monetary contributions is voluntary. You are free to cancel your membership at any time. OneShare requests that a voluntary sharing contribution be made for each month you are enrolled, to facilitate the sharing of requests published on behalf of other members.