If you or your family becomes unexpectedly sick or hurt, where should you go for care?
If your primary doctor is not available, you might go to the emergency room (ER). But you have another choice: urgent care centers. In most cases, an urgent care center can give you quicker care that costs less and is more convenient than the ER.
What are “urgent care” centers?
We consider urgent care centers to be clinics that give unscheduled, walk-in care for a sickness or injury, outside of a hospital ER. However, the urgent care visit must be performed and billed by a provider in our urgent care center network.
Network urgent care centers:
|MedExpress||677D Kidder Street||Wilkes-Barre||570-825-2046||Everyday, 9am-9pm|
|MedExpress||276 West Side Mall||Edwardsville||570-283-0791||Everyday, 9am-9pm|
|MedExpress||1953 East Third Street||Williamsport||570-323-4072||Everyday, 9am-9pm|
What do you pay if you use a network urgent care center?
- If you have a copay for a specialty doctor visit, you will also pay a specialty doctor copay for all services provided by the urgent care center.
- If you have a deductible and coinsurance for a specialty doctor visit, you will pay a deductible and coinsurance for all services provided by the urgent care center that are bundled into one charge.
What if you use a non-network urgent care center?
If you have covered services from a non-network urgent care center, we will pay for services according to how the center bills the visit. For example, it may be billed as an ER visit, outpatient visit or office visit. You would have to pay any cost-share amounts that apply. The services will not be covered under the urgent care benefit.
When is your primary doctor the right choice?
If you or your family needs care right away, try to reach your primary doctor. He or she knows your medical history, medications and health issues and can best help you:
- Plan care for minor problems, such as sore throat, earaches, rashes and minor cuts.
- Manage ongoing conditions, such as diabetes and asthma.
- Stay healthy by giving you preventive screenings and shots.
On the weekends and evenings, you may still reach your doctor by phone. He/she may help you choose the best place for care.
- Some doctors are available 24 hours a day.
- Some rotate with other doctors who are on call.
- In most cases, you can leave a message with the answering service. The doctor will get in touch with you.
When are urgent care centers the right choice?
If you can’t reach your primary doctor and it can’t wait, an urgent care center may be the right choice. If you are not sure how serious a health problem is, you should call 911 or go to your local ER right away. Then call your primary doctor as soon as possible.Your doctor will update your records and help you if you need more care.
You are the only one who can decide what’s right for you.
Check your member materials for your specific cost-share amounts and if you have an urgent care benefit. Please note that self-funded group benefits may be different from the benefits and services described here. Check your Summary Plan Description for complete details of your program.