Urgent care centers like DOCS Medical offer convenient healthcare for non-life-threatening conditions such as sprains, minor burns, or mild illnesses. Unlike emergency rooms, urgent care gives patients a faster, less expensive option that saves both time and money.
It can be difficult to understand exactly how insurance covers urgent care costs, thanks to variables like provider and plan specifics, deductibles, and out-of-network charges. But you can relax – we’ve got your back! The DOCS team is here to help simplify things for you.
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Most insurance plans, including HMOs, PPOs, and high-deductible health plans (HDHPs) – with or without a health savings account (HSA) – cover urgent care visits. However, details about what’s covered can vary widely between plans, especially concerning fees for co-pays, deductibles, and out-of-network care. Let’s break down what each type of plan typically covers.
(*NOTE: The table below lists coverage that’s common for popular insurance plans. Please read over your own plan carefully or contact your provider for more accurate cost estimates.)
| Insurance Plan Type | Urgent Care Coverage |
| Health Maintenance Organization (HMO) |
|
| Preferred Provider Organization (PPO) |
|
| High-Deductible Health Plan (HDHP) |
|
Before you get to the urgent care center, it’s helpful to know how to check your insurance coverage so you can avoid unexpected costs. You can take some of the steps below:
Review Your Insurance Plan Documents. Most health insurance plans send detailed explanations of benefits (EOBs) that list specific details for urgent care coverage. Look for sections on co-pays, deductibles, and out-of-network charges.
Use Your Insurer’s Online Tools. Many insurance plans offer online portals or mobile apps to help you locate in-network urgent care centers, estimate costs, and review co-pay or deductible requirements.
Call Your Insurance Provider. If you’re uncertain whether the urgent care center you’re considering is in-network, contact your insurance provider’s customer service center. A representative can confirm and provide you with an estimated cost for your visit.
Consider Telemedicine. Some insurance plans cover telemedicine visits, which can be an affordable alternative to in-person urgent care for minor issues. Virtual visits typically cost less than in-person visits, and can also save you time.
| Insurance Plan Type | In-Network Coverage | Out-of-Network Coverage |
| HMO | Usually fully covered with low co-pay | Rarely covered Higher out-of-pocket costs |
| PPO | Covered with low co-pay | Covered, but with higher co-pay or co-insurance |
| HDHP | Covered after meeting deductible Can use HSA for payment | Often covered, but with higher costs until deductible is met |
The UR HEALTH Plan by DOCS Medical offers an affordable healthcare membership for people without insurance or high deductibles. Membership includes:
Our convenient program has a one-time sign-up fee of $135 and monthly plans starting at $50 for individuals, with options to add on partners and families.
DOCS Medical Urgent Care services focus on delivering accessible, high-quality care when you need it most. Our goal is to create an affordable, convenient healthcare experience for a wide range of urgent medical needs, and ensure that every patient receives the attention they deserve. We pride ourselves on being a dependable resource for both acute and preventive care. Call us – we’re here to answer your questions about insurance coverage for urgent care.
Yes, most health insurance plans, including HMOs, PPOs, and high-deductible health plans, offer coverage for urgent care. However, specific coverage details vary by plan, such as network restrictions, or what co-pays and deductibles you must pay. It’s best to review your insurance documents or contact your provider for plan-specific information.
Urgent Care costs can include co-pays, co-insurance, and (potentially) out-of-pocket expenses until you meet your deductible. Co-pays range from $20 to $100 for most plans, while co-insurance might be around 10-30% of the cost of a visit after your deductible is met.Urgent Care costs can include co-pays, co-insurance, and (potentially) out-of-pocket expenses until you meet your deductible. Co-pays range from $20 to $100 for most plans, while co-insurance might be around 10-30% of the cost of a visit after your deductible is met.
To confirm if an urgent care center is in-network, check your insurance plan’s website or app for a list of approved provider centers. You can also call the customer service line or ask the urgent care center directly by phone or in person to see if they accept your insurance plan.
Urgent care is typically much less expensive than an ER visit. While urgent care co-pays are usually under $100, ER visits can cost several hundred dollars or more, depending on your insurance plan. ERs are best for life-threatening situations, while urgent care is ideal for non-emergencies that still need prompt attention.
Many insurance plans cover telemedicine visits for minor issues, especially because they’re generally less expensive than in-person visits. You’ll want to contact your insurance provider directly to confirm if virtual visits are covered and to understand any associated costs.
Yes, HDHPs cover urgent care, but you may need to meet a high deductible before insurance kicks in. HDHPs are often paired with Health Savings Accounts (HSAs), which can be used to pay urgent care expenses until the deductible is met.
Some insurance plans, like PPOs, offer partial coverage for out-of-network urgent care but often with higher co-pays or co-insurance. HMOs typically only cover in-network providers. If you’re considering an out-of-network center, check with your insurer to understand the cost differences.
Some insurance plans will reimburse you for out-of-network urgent care if you pay upfront, though this is not typical. You’ll need to submit a claim with receipts and documentation. Check with your insurance about their reimbursement policy for out-of-network services.
If your insurance claim is denied, contact your insurance company to understand the reason for the denial. In some cases, this could be due to using an out-of-network provider or a specific limitation in the plan. In many cases, you can file an appeal with your provider if you believe your plan should cover the service.
Yes, both HSAs and FSAs can be used to pay for your urgent care expenses. These accounts allow you to use pre-tax funds for eligible medical expenses, including co-pays, deductibles, and other out-of-pocket costs.
Yes, any out-of-pocket expenses at urgent care, like co-pays and co-insurance, typically count toward your deductible.
To save on urgent care costs, choose an in-network provider, use telemedicine if available, and consider using funds from your HSA or FSA if you have one. Reviewing your insurance benefits before you need urgent care can help you understand co-pays and deductibles and can also help you budget for potential future costs.
Our DOCS Health program offer access to all 17 of our locations with no co-pay or deductible for a low monthly membership rate.
With individual, family and business offerings, receive the quality care that you need at affordable pricing.
Urgent care provides immediate, walk-in medical attention for non-life-threatening conditions that require prompt treatment, such as minor injuries or illnesses. Our urgent care facilities have extended office hours and are equipped to handle a wide range of acute issues.
Primary care is long-term healthcare focused on overall health management, preventive care, and treatments for common illnesses and chronic conditions. Primary care providers (PCPs) serve as the main healthcare resources for our patients and will coordinate all your and your family’s healthcare needs.
Occupational health focuses on preventing and treating work-related injuries or illnesses to ensure that employees are healthy and safe in their work environments. Our occupational health services include health screenings, ergonomic assessments, and workplace injury management.
Our weight management programs aim to help individuals reduce body weight through dietary changes, exercise, and behavioral modifications. We can help you with medical supervision, nutritional counseling, and prescription medications to support your sustainable weight management.
Pulmonary care specializes in diagnosing and treating respiratory system disorders, including conditions like asthma, COPD, and lung infections. Our expert pulmonologists use a multitude of therapies and interventions to improve lung function and overall respiratory health.
Sleep treatment involves assessing and managing sleep disorders like insomnia, sleep apnea, and restless leg syndrome. Our sleep specialists use the latest diagnostic tools and therapies to help you achieve better sleep quality and support your overall health.
Our allergy services focus on diagnosing and treating allergic reactions to various triggers, such as pollen, food, or medications. The allergists at DOCS Medical conduct tests and provide treatments like immunotherapy and medications to help alleviate and manage your allergy symptoms.
Chiropractic care specializes in diagnosing and treating musculoskeletal disorders, focusing on the spine and associated nerves. Our chiropractors use manual adjustments and other techniques to relieve pain, improve mobility, and promote your overall wellness.
Behavioral health encompasses the treatment of mental health disorders and emotional well-being, addressing issues such as anxiety, depression, and substance abuse. Our behavioral health experts use therapy, counseling, and medication management to help support your mental well-being.
DOCS Now is telemedicine for your everyday life. Telemedicine leverages technology to provide remote medical consultations and care, allowing patients to connect with healthcare providers via video calls or phone consultations. Our approach to telemedicine enhances access to healthcare, especially for those living in remote areas or anyone who has mobility challenges or difficulties leaving home.
Did you know that DOCS has Primary care services, allergy testing & treatment, chiropractic care and more availabile in addition to urgent care?
Stop in or book now to come in to see one of our providers today!
