Smart choices for your next sick day
Let’s set the scene: It’s after hours, your stomach is doing flips, and you’re Googling symptoms like a detective on a crime show. “Do I need the ER? Or urgent care? Can I just call someone while in pajamas? How much is everything going to cost?”
You’re not alone. One of the most common questions we hear about a health plan is: Where do I go when I need care? How much will I have to pay?
The answer can save you money, time — and a lot of stress.
The Emergency Room (ER): Severe Pain or Life-Threatening Situations
Pure and simple: Go to the ER or call 9-1-1 right away when it seems life threatening.
• ERs are open 24/7/365, equipped to handle a wide range of medical emergencies.
• For example: Chest pains, stroke symptoms (face drooping, slurred speech), serious injuries or bleeding are serious emergent situations.
• Anything that makes you say “this is really bad” is a clear sign you need ER assistance.
Urgent Care: The Middle Ground for Minor Mishaps
Think of urgent care like the reliable friend who shows up just when you need them — after hours and on weekends — outside of regular clinic hours. It’s great for:
• Illnesses and injuries that need attention right away
• For example: minor burns or sprains, pink eye, fevers (that aren’t scarily high), ear infections Urgent care visits typically cost less than the ER—with the potential of shorter waiting times. Your insurance might cover it just like a regular doctor’s visit but check with your insurance company first.
Telehealth/E-visit: The Couch-Friendly Option
Feel an illness coming on but don’t want to leave the house (or your dogs on your lap and you’re not moving)? Telehealth is perfect for many common conditions:
• Most cases, a quick questionnaire is asked by the telehealth office
• Illnesses like sore throats, allergies or rashes, colds are good use of telehealth visits
• You will usually receive a treatment plan and receive a prescription or medication refill if needed
• Quick mental health check-ins may be available as well Many health plans offer low-cost or even free virtual visits. However, not all plans offer this benefit, so check with Evidence of Coverage for specific information. If it’s offered, it’s easy, fast, and your insurance plan may even help you schedule one.
Primary Care:
It’s best to see your primary physician, whether it be in person or via a telehealth visit, for non-emergency preventative or routine care. Commonly, primary care physicians:
• Know you and your family health history to better care for you and your needs
• Keep you healthy with regular checkups, vaccinations, and screenings
• Help you control potential issues like high blood pressure, diabetes, and asthma
• Can detect future potential health issues Most health insurance companies encourage you to see your primary physician because it will help lead you to healthier outcomes and help lower your costs.
Why Your Health Plan Cares Where You Go
We’re not just being nosy. Helping you get the right care in the right place helps everyone:
• You avoid high out-of-pocket bills
• The system avoids overcrowded ERs
• Your premiums are more affordable True story: One person went to the ER for a paper cut. That turned out to be a $1,200 bandage.
Can It Really Cost That Much? Yes. Here’s Why.
Think of ERs are like five-star resorts (but one you really don’t want to go to). First and foremost, they’re ready for anything, 24/7. Even if you don’t need the deluxe service, you’re still paying for the full experience.
ERs are built to handle the most serious, life-threatening situations at any hour. That means:
• More equipment (like CT scanners, trauma rooms)
• More staff (doctors, nurses, specialists on call)
• Higher overhead costs (lights on all night, rooms always prepped) When you go to the ER — even for something minor — understand that you’re paying for that full setup, whether you need it or not.
Insurance companies cover most ER visits, especially for real emergencies. But if you go to the ER for something that could have been treated elsewhere (like a sore throat or mild rash), they may pay less—meaning you may owe more—because it wasn’t the most costeffective place for that care.
That’s why insurance plans cover emergencies — but may not pay as much if it turns out you didn’t need to be there. It’s why insurance companies encourage you to check in with your health plan (most health plans have an app for this) before you leave.
Not Sure Where to Go? Try This Quick Guide:
Just Remember:
• Always check if the place you’re going is innetwork. Out-of-network = more money from your pocket. (Emergency care is often covered even if out of network.)
• Look for a nurse advice line or virtual care in your insurance app. We build these tools for a reason—feel FREE to use ’em! Many health plans will: - Help you find nearby urgent care clinics - Connect you to a virtual doctor - Tell you what you might owe depending on where you go The Bottom Line:
We as health insurers know health care can feel confusing. But choosing where to go shouldn’t be.
• If it’s serious or if you are not sure —call 9-1-1 or go to the ER. End of story. Your health and life are far more important than anything else.
• If it’s urgent but not an emergency—urgent care or call your primary physician.
• If it’s something small or you’re just not sure—telehealth or your insurance nurse line is a great place to start.
When in doubt, don’t guess — ask. That’s why we’re here.
Knowing where to go for care-and when to involve your insurance company-can make a big difference in how much you may pay and how quickly you feel better overall. By thinking through your options or checking in with your health plan first, you can avoid surprise bills and get the right care at the right location.
Because your health matters most in the moments that matter.
— By Andrew Marshall, Medica Minnesota Market President
