Most employees pick where to go for care while they are sick, and the choice is often the expensive one.
A plan can cover a primary care doctor, a nurse line, virtual visits, walk-in clinics and the emergency room. Employees who know which door fits which problem use the plan better, and the right choice is usually the cheaper one for them and for the group.
Five places to start, and when each one fits.
Your Primary Care Doctor
The best first stop for ongoing conditions, prescriptions, check-ups and anything that can wait for an appointment. A doctor who knows the patient and their history is hard to replace. This is usually the lowest cost setting under the plan as well, though copays vary by plan.
The 24/7 Nurse Line
A registered nurse by phone at any hour, useful when someone is unsure whether a symptom needs care at all. It sorts the question out; it is not a visit.
Virtual Care
A video or phone visit with a provider for common, non-emergency problems, without the drive or the waiting room. Useful in the evening or on a weekend.
Walk-In and Urgent Care
For problems that need to be seen today and are not life-threatening, such as a minor cut, a minor burn or a sprain, when the doctor cannot fit the patient in. Costs are usually higher than a primary care visit but lower than an emergency room, though copays vary by plan, so check the benefit summary.
The Emergency Room
For serious or life-threatening problems. Employees should not hesitate to use it when they believe it is an emergency, and should call 911 for anything that cannot wait.
MedlinePlus lists signs such as severe chest pain or pressure, severe trouble breathing, sudden weakness or drooping on one side, sudden trouble speaking or seeing, fainting, heavy bleeding, and a seizure lasting more than a minute. These are examples, not a complete list.
Not Sure Which One
Start with the nurse line. A short call can point to the right setting, which is the whole reason the line exists.
The question to put on the benefits poster.
Is This an Emergency?
If the answer might be yes, go to the emergency room or call 911. Nothing on this page should delay that.
If It Is Not an Emergency
Call the doctor, call the nurse line, or start a virtual visit. If it needs to be seen today in person, a walk-in or urgent care clinic is usually the next step. Plan materials or the member ID card typically list the nurse line and virtual visit options, and keeping that information handy saves time when someone feels unwell.
Why Employers Care
Care in the wrong setting can cost more and take longer, and those costs can show up at renewal. Clear guidance helps the employee first, and the plan second. Employers can help by sharing plain, short guidance before open enrollment so employees know their options before they need them.
What We Do About It
We include a one-page guide in open enrollment materials, with the right numbers for each carrier and plan, so employees are not searching the website when they are unwell.
What we would settle before putting this in front of employees.
Which Clinics Are in Network?
Walk-in, urgent care and virtual options differ by plan and by carrier. We confirm which are covered, and at what cost to the employee, before anything goes on a poster.
What Does Each Setting Cost the Employee?
Copays and cost sharing differ between a primary care visit, urgent care and the emergency room. We list them side by side for each plan we quote.
Where Do Employees Find This?
A guide employees cannot find does not get used. We would put it in the enrollment packet, the benefits portal and the 24/7 chat on our site.
Common questions about choosing where to go for care.
Is urgent care the same as the emergency room?
No. Urgent care treats problems that need prompt attention but are not life-threatening. Serious or life-threatening problems belong in the emergency room, and your plan documents describe how each is covered.
Can the nurse line tell someone where to go?
Carriers describe their nurse lines as helping members decide on a care setting. The nurse gives guidance by phone and does not replace a visit. Details vary by carrier, so confirm yours. You can see every carrier on our nurse lines by carrier page. We have pages on the Blue Cross, Blue Care Network, Cigna, Aetna and UnitedHealthcare, Priority Health, HAP McLaren, Anthem, Humana, Angle Health, Paramount, Total Health Care and Alliance Health and Life nurse lines.
Does every plan cover virtual and urgent care?
Not all services are covered by all plans, and cost sharing differs. We check the plan on the table for each setting before recommending it.
Where this comes from.
The emergency and urgent care guidance on this page follows MedlinePlus, a service of the National Library of Medicine. It is general information, not medical advice. Employees with a health concern should talk to a clinician or call 911 in an emergency.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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