Does Visitor’s Insurance Cover Urgent Care?

Does Visitor’s Insurance Cover Urgent Care?

05 March 2020 |

You’re on holiday in the United States when you trip and fall, spraining your wrist. Perhaps you’ve come down with the flu that’s going around, causing you to have a high fever. Luckily, you’ve planned ahead and enrolled in a health insurance for visitors plan, so you’ll be able to take care of your medical needs. All you’re wondering now is, does visitor’s insurance cover urgent care? The answer is usually, yes. Here’s everything you need to know about this valuable type of medical care in the United States.

Overview of Health Care in America

The most important thing to know before visiting the United States is that health care is not free, for citizens or visitors. Visitors will not be covered by the Affordable Care Act and they are always responsible for paying for their medical care. This is why it’s so important to purchase visitor’s insurance before coming to the United States.

With insurance, you’ll be able to take advantage of many different types of medical care you may need while you’re here, from visiting a doctor for an illness to major accidents. But does visitor’s insurance cover urgent care? And how do you go about using it? First, let’s talk a little about the U.S. health care system, what urgent care is, and when you would need to use it.

What Is Urgent Care?

Most people are familiar with emergency room care, as well as with typical doctor visits, where you would schedule an appointment a day or two beforehand with a primary care physician. Emergency room care is meant to be reserved for life-threatening situations, for example, if there is a lot of bleeding, open wounds, chest pain or difficulty breathing, broken bones, and other major physical conditions.

Primary care physicians treat illnesses that are not life-threatening, for example, if you’re on holiday in the USA and need a doctor for a cold or flu, a minor cough, skin problems, ear infections, and so on. However, many tourists are surprised to learn that they often cannot see the doctor immediately and must wait a few days for an appointment.

Urgent care is meant to fill the gap between emergency room visits and primary care physicians. If you’re unable to get an appointment quickly with a doctor, or if you have a condition that is not life-threatening but is extremely uncomfortable or is inhibiting your daily life, you could go to urgent care. Some common examples of urgent care for tourists include:

  • Sprains and minor fractures
  • Severe sore throat or cough
  • High fevers
  • Vomiting
  • Diarrhea
  • Dehydration

Benefits of Urgent Care for Tourists

Urgent care centers were created to help ease crowding at emergency rooms and ensure that emergency care is reserved for truly life-threatening situations. By splitting up emergency rooms and urgent care, both groups of patients have their needs taken care of faster, which is a benefit for everyone.

Urgent care is often more convenient than seeing a primary care physician as well because you don’t need an appointment and they often have longer hours, including nights and weekends.

Urgent care centers are also able to see many more patients per day and keep costs down because they’re staffed by nurse practitioners and physician assistants. At an urgent care center, you may not see a medical doctor, although there will be one on staff. One organization estimates that for the common condition of acute bronchitis, an urgent care visit will cost you $127 while treating the same condition in the emergency room could cost $595!

With travel medical insurance, your cost will be even lower—perhaps just copay. Low costs make urgent care the perfect clinics for tourists, although it is still recommended that you follow up with your regular doctor.

If your visitor’s insurance does cover urgent care, the insurance company will often prefer you to go there rather than the emergency room, because it keeps their costs down, as well. Some providers may even penalize you if you visit the emergency room when it is not needed, instead of going to urgent care.

What to Know Before You Go

Going to urgent care is a straightforward process, for both tourists and American citizens. Here are the most important steps to take to ensure that, when your visitor’s insurance does cover urgent care, you will be covered.

1. Find an In-Network Clinic

With most visitor’s insurance, you won’t be able to simply go to any nearby urgent care clinic. You’ll need to visit one that is in-network for the insurance plan you have. Call the number on your ID card to find out which clinics near you are in-network.

2. Know What to Bring

Unlike a primary care physician, urgent care clinics won’t be familiar with your medical history and won’t have any records on file. Make sure you bring the names of medications you’re taking and any conditions you’ve been diagnosed with. Always bring a picture ID to verify your identity, and if your visitor’s insurance does cover urgent care, bring your ID card and be prepared to answer a few questions.

3. Be Aware of Pre-existing Conditions

Does visitor’s insurance cover urgent care that stems from pre-existing conditions? Most of the time, it does not. Pre-existing conditions are any illness, injury, or medical condition that you’ve been diagnosed with prior to the start date of your insurance plan.

For example, if you’re on holiday in the USA and need a doctor for a bout of hypoglycemia, you may not be covered, because diabetes is a pre-existing condition. However, you can purchase coverage for pre-existing conditions separately or as an add-on to your policy.

Can You Go to Urgent Care Without Insurance?

We’ve established that visitor’s insurance often does cover urgent care—but what if you don’t have insurance? Or what if you need medical attention for a pre-existing condition, and forgot to add it to your policy?

The good news is that you can go to urgent care without insurance. In America, emergency rooms and urgent care centers cannot turn you away simply because you don’t have insurance. However, due to the cost concerns we discussed above, urgent care clinics for tourists are often the best option for those without insurance. Here’s what you need to know.

How Much Does Urgent Care Cost?

Urgent care for tourists is often a cost-effective option, especially when compared with the emergency room. Because you’re seen by nurse practitioners or physician assistants, it might even be cheaper than seeing your primary care physician. Check out the chart below to see the cost of some common conditions.

ConditionUrgent CareEmergency Room
Acute bronchitis$127$595
Strep throat$111$531
Upper respiratory infection$111$486
Ear infection$110$400
Sinusitis$112$617

Source: Debt.org

Does visitor’s insurance cover urgent care entirely? If you have visitor’s insurance that covers urgent care, the cost of your visit will usually just be a copay. However, it may also count toward your deductible, so always check with your provider before you head to urgent care.

How Can I Save Money at Urgent Care?

Even with the lower costs of urgent care, many people still struggle to pay for unexpected medical costs, especially tourists. Most of us simply don’t budget for accidents and unforeseen circumstances like medical emergencies when budgeting for a trip—but they do happen. Here’s how you can save money if you find yourself in an urgent care situation.

First, check rates online. Many urgent care clinics post their cash prices on their website. If you don’t see them online, try calling the clinic. They may be able to tell you prices for common services. While you have them on the phone, ask about discounts for paying cash. They may offer cheaper rates for patients paying out-of-pocket—or you may be able to negotiate one.

Once you’re there, you might find your bill is quickly adding up. If you don’t have visitor’s insurance that covers urgent care, you should ask about payment plans. Many clinics offer options with low or no interest. You’ll get the care you need and have more time to pay the costs. Finally, always make sure you check your bill. Everyone makes mistakes, but you don’t want to pay for double charges or for services you didn’t receive.

Urgent Care for Tourists: The Final Word

While visitor’s insurance usually includes coverage for urgent care, you should always ensure the visitor’s health insurance plan you choose includes this important coverage. It can be the difference between seeing a doctor today or having to wait several days. If you have a pre-existing condition that may necessitate a visit to urgent care, make sure that you also opt for that type of coverage. Pre-existing conditions aren’t covered under most regular plans.

Urgent care is usually cost-effective, even for those who don’t have insurance. If you’re on holiday in the USA and need a doctor, urgent care could be the solution you need, whether you have insurance or not.

VisitorGuard.com