Why is My Copay Higher for Urgent Care Centers? - Urgent Care FAQ's

Why is My Copay Higher for Urgent Care Centers?

Why is My Copay Higher for Urgent Care Centers?

Urgent care facilities have a higher overhead than most primary care physicians. On top of that, insurance companies feel that, in general, the overall cost is going to be higher at urgent care.

Cost Compared to Primary Care Physician

Most insurance companies charge a higher copay for going to an urgent care facility than if you go to a primary care physician. There are a few reasons for this. First, urgent care centers generally have a higher overhead cost than a traditional clinic. While they are not dealing with life threatening issues like an emergency room, they do have to plan and staff for the unexpected. Whereas most medical offices take appointments and can plan their schedules accordingly, urgent care centers are always “on.” Additionally, these facilities have to do a lot in the way of diagnostics. All this gets expensive which means going to an urgent care is going to cost more than simply going to your family doctor. On top of that, many insurance companies choose their copays based on the estimated cost of a visit. Because urgent care is going to be treating you on an urgent basis, it is likely that the care is going to cost more than a routine checkup with a primary care physician. This is one of the biggest factors in a higher copay for urgent care. This said, most health plans offer urgent care copays ranging from $35-75 per visit while primary care copays range from $20-50.

Cost Compared to Emergency Room

Though urgent care is more expensive than visiting a primary care physician, it's important to note that it is cheaper than going to the emergency room. This is because the emergency room has a much larger overhead. They need to staff more robustly including specialists, surgeons and nurses, as well as house and maintain specialized equipment for life threatening diagnosis and treatment. Not only is the copay for visiting urgent care lower than visiting the emergency room, the overall cost of diagnostics and procedures are also lower. Because of the lower cost, if it is possible to visit urgent care, it is suggested in most cases. However, keep in mind that urgent care is not appropriate for life-threatening conditions.

Overall Cost

The overall cost of visiting an urgent care facility is going to vary depending on the condition being treated. On top of this, it will depend on whether or not you have insurance, as well as the insurance provider and specific plan you are a member of.