When you or a loved one has a medical emergency or serious issue that requires prompt care, choosing how and where to seek help can be confusing, time-consuming, and sometimes more costly than necessary.
There are a couple of options to choose from when it comes to receiving emergency care:
- Emergency rooms (ERs) offer the highest level of emergency care for life-threatening conditions. Patients typically pay more out of pocket for ER services than other types of emergency care. They also may face long waits and risk exposure to other sick people in the waiting room.
- Urgent care centers can treat common conditions such as the flu, urinary tract infections, minor cuts, sprains, bruises, and animal bites. Many are open for extended hours and offer X-rays and lab work onsite. If you don’t need an ER, urgent care centers can save you money and time. In addition to waits that are typically shorter than in the ER, urgent care centers often allow patients to schedule appointments in advance.
- Virtual care is frequently an option for non-emergency conditions like colds, flu, and coughs.
Before you seek care, ask if the facility or service you intend to use is part of your health insurance plan’s network. Many plans, including Cigna Healthcare, offer network information on their website, mobile apps, and through a round-the-clock phone service.
Beyond these general guidelines, we asked Dr. Peter W. McCauley Sr., a medical officer for Cigna Healthcare, for tips on when to visit an emergency room, an urgent care center, or a virtual care provider – and when to reach out to your primary care provider (PCP) or to call 911.
Let’s start with the most serious medical needs. When should you call 911?
Reasons to call 911 include:
- Severe bodily injury, such as significant head trauma from a fall
- Any penetrating injury resulting in significant blood loss
- Sudden loss of consciousness without the ability to arouse
- Chest pain and/or difficulty breathing that could be indicative of a heart attack
- Sudden facial drooping with speech difficulties and limb weakness, which could indicate a stroke
In children, these symptoms are also reasons to call 911:
- Constant vomiting or diarrhea resulting in sleepiness or confusion
- Significant difficulty breathing
- In infants less than 2 months old, a temperature at or above 100.4 degrees Fahrenheit (38.0 degrees Celsius).
What else should I know about calling 911?
Most people recognize 911 as the national phone number to dial for emergencies to access police, the fire department, or ambulance services. The majority of health-related 911 calls are on behalf of someone else who may be in acute distress.
When someone requires transport to an emergency room, the ambulance is almost always dispatched to the nearest ER. Patients and their representatives usually cannot request a particular ER or hospital.
Should you call the patient’s doctor before heading to an ER or urgent care facility?
Yes, if at all possible. The patient’s doctor can help determine if going to the ER or urgent care facility is the best option. Perhaps even more importantly, if the decision is to go to the ER, the doctor can often call ahead to provide the ER staff with important information about the patient’s situation. The doctor also can ask that the treating doctor in the ER keep them informed about treatment plans or interventions. This will help promote continuity of care, which is in the patient’s best interest.
Can you recommend steps to take now to prepare for medical emergencies?
Because many emergencies occur at home, you should plan to "know before you go.”
Part of this process is establishing a relationship with a primary care provider and learning how to reach the provider or office staff after hours. In emergency situations where stress is high, the doctor or staffer can help you determine whether to seek care in an emergency room or an urgent care center, or if you should visit the PCP’s office (in person or virtually) the following day.
You also should familiarize yourself with nearby hospital facilities in case you need to go immediately to an ER. You will want to ask if your PCP is on staff at the hospital or has a professional relationship with the hospital, and if not, would they use that facility for themselves or family members?
What about emergency plans for children?
Understand how to reach the office for medical advice when you need it after hours. Keep the doctor’s office and after-hours phone numbers posted where they are always visible, such as on the refrigerator, so that information is always available to anyone caring for the children, such a nanny, sitter, or grandparent.
When you have those phone numbers, don’t hesitate to use them: Err on the side of caution and call for medical advice – and advise other family members and caregivers to do the same.
Identify the nearby hospitals where your child’s doctor is on staff or admits patients, and keep that information handy as well.
Is virtual care an option for urgent needs?
One of the most valuable lessons that we can take away from the pandemic is that many medical conditions can be treated virtually, using technology that allows the provider to talk with and see the patient. These virtual visits can be used for conditions like uncomplicated rashes, eye infections, sore throats, coughs, or cold symptoms without significant fever.
Virtual care has other benefits as well: it can be scheduled at a convenient day and time; it can be accessed from virtually any location that has Wi-Fi; it can be less costly than other types of care, with many visits charged at a flat rate; and it eliminates potential exposure to communicable diseases from other patients in a waiting room.
Does virtual care save money?
Research from Cigna Healthcare found that virtual care offers a number of direct and indirect savings.