Is that sore throat an emergency?

Knowing when and where to go when you get sick or injured helps ward off unplanned and expensive medical bills
January 4th, 2017

Graphic showing when to go to an ER versus an Urgent CareOver the past few days, you’ve noticed you’re sniffling more than normal, and sneezing — probably allergies. “I’ll survive,” you tell yourself. But later you wake, feeling extremely sick in the middle of the night. Your throat is so swollen you can’t drink the soothing tea you made at 4 a.m., and your doctor’s office isn’t open yet.

“Maybe I should go to the emergency room?” you ask yourself. You feel miserable.

Deciding whether to go to an emergency room, an urgent care or to wait for your primary care physician’s office to open is a choice many of us have encountered.

According to a 2013 study by Truven Health Analytics, 71 percent of the visits to emergency departments could have been treated at either an urgent care or doctor’s office.

“We see a lot of respiratory issues this time of year,” said Dr. Jamie Teumer, medical director of UCHealth’s Medical Center of the Rockies Emergency Department. “And I’m not talking about the people who are having trouble breathing; rather, it is those with sinus symptoms or a cough for a few days. These people are easily treated, and they don’t need to be coming to us.”

Emergency departments, open around the clock, provide care for complex and serious injuries and illness. They are equipped with expensive technology – MRI’s, CT scans – and should be used for serious and life-threatening illnesses and serious injuries including severe burns, head or neck injuries, deep wounds or a broken bone protruding from the skin. Emergency departments are for patients who are coughing up or throwing up blood, having heart attack or stroke symptoms, or experiencing poisoning or an overdose of drugs or alcohol. Patients who come to the emergency department for a sore throat pay extra to be in the emergency room.

“If you are coming to an ER, it’s about complexity,” Teumer said.  “Charges at an ER are always significantly higher than if you were to go to an urgent care because you are paying for us to never be closed and always be ready.”

So what should you do?

“Always call your primary care doctor before you go to either an emergency room or urgent care,” Teumer said. “They know you best and can help direct you to the right place. They always have someone on call if it’s after hours. But, if it’s significantly urgent, you shouldn’t be calling anyone but 911.”

So, in the case of your swollen throat — which by now probably includes chills and back pain — call your primary care doctor or visit an urgent care clinic.

“If your primary care doctor can get you in, cost-wise, that’s usually the best,” said Dr. Kelby Bethards, medical director for UCHealth’s northern Colorado urgent care clinics. “If they can’t, then they can guide you to us (urgent care clinics).”

UCHealth plans to open two additional urgent care clinics in the Denver-Metro area. See a map of UCHealth urgent care locations.

Urgent care clinics provide medical care for such ailments as a sore throat, cold, flu, ear ache, migraine, urinary tract infections or low-grade fever. They should also be used for minor injuries, such as sprains, back pain, minor cuts and burns, broken bones or minor eye injuries. However, urgent care clinics don’t replace one’s primary care office, Bethards warned.

“Urgent cares don’t provide primary care services such as vaccinations, health care maintenance blood work, such as cholesterol checks, or long-standing medication refills (except in extenuating circumstances),” he said. “We are not an overflow for non-acute issues.”

So ask yourself a few questions before you rush to the closest ER.

1. Is this life-threatening? If it is, call 911 for ambulance transport to the nearest ER.

2. Can this wait until office hours? If it can, call your primary care office when they open to see if you can get in. Your primary care doctor has access to your medical records and knows your medical history best.

3. Can this wait until an urgent care clinic opens? Urgent care clinics usually open earlier and stay open later than physician offices, as well as being open on weekends. So, if you can’t get into your doctor’s office, waiting until you can be seen at an urgent care will save you coming home with a large ER bill.

Being prepared before something goes wrong is also helpful. Here are things to consider.

4. How do you reach your doctor? Write your doctor’s number and after-hours number down and put it somewhere easily accessible, or even save it in your phone’s contacts. This way you can easily reach your chosen health care providers in urgent situations.

5. Where are the closest urgent care clinics and what are their hours? Knowing where you can go when you are feeling sick or dealing with a minor injury helps prevent you from making the last-minute turn into the closest ER.

Also, don’t be confused between free-standing ERs and urgent cares. Free-standing ERs are clearly marked inside and out with ER signs and oftentimes are strategically located some distance from a hospital to provide that region access to emergency care. However, these ERs bill the same as hospital emergency rooms.  Often, an urgent care location is nearby. So if you do find yourself arriving at an ER for a non-emergency, don’t hesitate to ask the staff where you can find the closest urgent care.

6. Who takes your insurance? Although most urgent cares take a variety of insurances, there are some exceptions, and those exceptions could mean a larger bill. Knowing this ahead of time can save you added stress. Call your closest urgent care and see if they handle your insurance before you need them.

In 2013, the average ER visit cost more than $1,233, while the average doctor or urgent care visit ranged from $50 to $150, according to the National Institute of Health. By being prepared and knowing your options, you can be better prepared for the unexpected — which won’t include a high-priced emergency room bill.