Little known ways to save money and improve your access to health care
Many people do not understand the levels of health care. It can be expensive, a waste of time or downright dangerous when choosing the wrong levels of care. The levels of care from highest to lowest is hospital care, emergency room, urgent care, primary care, convenient/express care and telemedicine/virtual care. I have worked in all of these levels of care over the years.
When thinking about your illness or health problem, consider which level of care will solve your problem best. This step will save you money and time and often can save you from unnecessary testing.
Hospital care means you need to be hospitalized to receive care, obviously. This is care requiring IV fluids, medications, nursing care, and care for potentially life-threatening conditions. Hospital care can bankrupt people, even those with excellent health insurance. The bill can be in the millions of dollars. Sometimes, once you are stable, the hospital may discharge you with nursing care or IV antibiotics to be done in your home.
Emergency department care is for treatment of life-threatening emergencies like a heart attack, stroke or a serious infection or injury. ER care is very expensive as is a trip in an ambulance which is often charged separately and may not be covered by insurance. Legally, the ER cannot turn people away, so if you turn up for a hangnail or a terrible pimple on your chin, they cannot turn you away. People often go to the ER because they are open 24/7 and on holidays and they don’t want to miss work and they don’t want to make an appointment. They may not be able to get a timely appointment with their primary care doctor. One woman I know cannot afford to pay her medical bills and she knows the ER won’t turn her away. She has no intention of ever paying her medical bills, she tells me. She just goes to new doctors once her old doctors won’t see her any more for nonpayment.
The ER has equipment to perform X-rays, blood work, MRI, CT scans and to get results quickly. The ER has medications, IV fluids, nurses and health care staff to handle every health condition. They can identify and treat life-threatening conditions. But when the ER is overrun with minor medical conditions like rashes or minor infections that should have been treated at a lower level of care, a really sick patient may end up waiting too long for safe care.
Urgent cares are the next level down. Urgent cares can check for a urinary tract infection, strep throat or flu but may not have capability to do other tests. Urgent cares don’t have MRI or CT scans and they may or may not have an X-ray machine. It depends on the facility. If there’s a chance you are having a heart attack, stroke, or serious illness, the urgent care will send you to the ER. In this case you may end up with 2 bills, for the urgent care and the ER.
Your primary care clinic doctor or nurse practitioner is the best place for most illnesses but they are usually open banker’s hours. No evenings, weekends or holidays and you must get an appointment. This is unfortunate for people working banker’s hours because you must take time off for an appointment. In primary care, you are seen for “well” or “sick” visits. Well meaning a Pap smear, breast exam, routine vaccinations, routine labs (such as for diabetes, cholesterol or thyroid). A sick visit is a problem visit like for an injury, knee pain, mild infection or even more serious problems requiring blood and imaging. In primary care, we can order X-rays, CT scan or blood tests, for example, but may not get the results for several hours or days.
Convenient or express care can be found at your local pharmacy or sometimes at an airports where you can be treated for very mild illnesses or conditions. The price for convenience care is often less than for an office visit, less than $100, usually. They can do quick tests for strep throat, flu or a urinalysis to evaluate for urine infection, for example. They often have a la carte menu where you pay for each test.
Telemedicine is the lowest level of care and you won’t be getting an in person physical examination. A telemedicine visit can cost as little as $20. It’s best if you can provide relevant information for the telehealth visit such as your temperature, blood pressure, pulse and weight. I recommend you purchase a pulse oximeter to have in your home. This is an inexpensive (~$15) device that measures blood oxygen. Normal blood oxygen is in the high 90s, but if your oxygen is dropping to low 90s or even in the 80s you may require hospitalization and supplemental oxygen. Telemedicine is useful for simple rashes, oral contraceptive refills, pink eye, most viral illnesses and uncomplicated urinary tract infections, for example. If you have a potentially life threatening or serious illness, telemedicine is not recommended. Your telemedicine provider may recommend you be seen in a higher level of care such as an in office appointment, urgent care or ER, depending on the severity of the illness. With telemedicine, we may be able to order labs or an X-ray or other imaging. If you aren’t sure what level of care you need, it’s reasonable to start with a telemedicine visit. There are 2 different kinds of telemedicine visits: asynchronous and synchronous. Asynchronous is when you put in all your information in the computer platform, it’s sent to the provider and they make a decision, give you advice and send in a prescription if relevant. There’s no back and forth communication with asynchronous, so this is very limiting, but useful for certain conditions. Synchronous is when you are on a video or phone call communicating back and forth in real time.
Understanding these levels of care may help you to be a better healthcare consumer and choose the correct level for your ailment. I hope this information is helpful to you! Let me know if you have any questions in the comments!