Co-pay? Deductible? Co-insurance? Health insurance and paying for medical care can be confusing for some of us. Use this quick guide to help you understand when and how much you may end-up paying for your urgent care visit.
If You Are Paying Cash or Won’t Be Using Health Insurance
If you don’t have, or are planning not to use, health insurance during your visit MedSpring Urgent Care offers reasonable self-pay rates reflecting a discount for prompt payment. Based on your stated reason for coming in to see us, we can provide an estimate for the cost of your visit during check-in. After you meet with your healthcare provider, depending on the scope of care and services provided, the final cost of your visit may be different than the initial estimate.
If Your Insurance Includes a Co-Pay
What is it? Your co-pay is the fixed amount that you pay for medical care and is usually collected at the time you receive your medical services. Your urgent care co-pay amount may be different than the amount you would pay for a doctor’s office or ER visit.
Some insurance carriers may have preferred urgent care locations that they want you to use. If this is the case, the amount of your urgent care co-pay may differ depending on where you go - even if there is a specific urgent care co-pay amount printed on your insurance ID card. Some insurance carriers have preferred, in-network, urgent care companies and in these cases your co-pay may be a little higher to visit one that is out-of-network.
If Your Insurance Includes a Deductible
What is it? Many plans include a deductible - the amount you pay for health care before your health insurance begins to pay. With the deductible you pay 100% of your medical care until your deductible amount is met. After that, you and your insurance share in the cost of care. The deductible for an urgent care visit can be up to a few hundred dollars, depending on your total deductible paid so far for the plan year.
If you have a plan with a high deductible then you will have cheaper monthly rates for your insurance, but you will likely pay more up front when you need care. Some plans may cover the full amount of certain medical services before your deductible is met.
If Your Plan Includes Co-Insurance
What is it? Co-insurance is your share of the cost you pay for your health services, and begins after your deductible has been met. Your co-insurance percentage is the amount that you will be responsible to pay for your care. The remainder is what your insurance plan pays. For some, you may have both a co-pay and co-insurance. The co-insurance amount you may pay for an urgent care visit can be 20% to 40% of the total amount due depending on your insurance plan.
If you choose an out-of-network provider, you will likely pay the difference between the cost of the services you receive and the cost your insurance carrier would have paid for an in-network provider. If you have an HMO plan, a referral may be required before coming in to urgent care.
Work Related Urgent Care Visits
If your visit is due to a work related injury or illness, your employer or your employer’s workers’ compensation insurance will be billed for services authorized in advance by your company. For your convenience we do our best to work directly with your employer in order to process the work related claim.
Injuries or illnesses that happen at work cannot be combined with visits that are non-work related due to state and federal regulations. If you have healthcare needs in addition to your work related visit, we will schedule a separate urgent care visit for you and gather your personal insurance information.
After Hours Visits
If you visit after standard business hours (after 5pm on weekdays, or on weekends and holidays), the cost of your care will include a $25 After Hours Visit fee. Some insurance plans cover this fee. If your insurance plan does not cover some or all of this amount it will be added to your amount due.
How the Amount You Owe is Determined
During your visit we make an effort to reach out to your insurance carrier to verify your benefits. We use this verification to estimate the amount you will need to pay and how much your insurance will cover. At the end of your visit we will collect the amount you owe. Your amount owed may include a deductible or co-insurance based on the information your insurance carrier provides to us even if you paid a co-pay or a deductible amount.
Next, we will file a claim with your insurance provider after your visit. We will send you a statement for any remaining balance due based on the amount paid by your insurance, or promptly process a refund if applicable. If your insurance provider denies part or all of your claim, then you will be billed for the remaining or full amount of your visit.
Contact your insurance provider if you have questions or need to verify coverage in advance of your urgent care visit. They can provide answers and offer more information regarding your personal coverage, deductibles, co-insurance or co-pays.
For questions related to your MedSpring Urgent Care bill or amount owed when you receive your bill, feel free to call Customer Service from 9am to 9pm CT, seven days a week at 888-980-0505 (link is external).