Emergency departments and urgent/walk-in care centers provide expert medical care, but they are different when it comes to scope of services. The Yale New Haven Health Medical Plan includes coverage for the care you need, when you need it – including emergency care and urgent/walk-in care – but understanding the differences can save you time and money.
Emergency departments are equipped to treat life-threatening conditions. Urgent/walk-in care centers deliver prompt medical care for non-life threatening illnesses and injuries. Some conditions may also be appropriate for a video visit. As a result, your copay for treatment from an urgent/walk-in care center will be lower.
The most important thing to consider is the type of treatment you may need. The ED is equipped to see people with unexpected, intense and immediate symptoms or injuries, such as chest pain, difficulty breathing or severe pain or bleeding. Many health problems, however, can be treated in urgent care/walk-in centers, such as sprains, fractures, colds/flu, seasonal allergies, minor burns and many others. You’re also more likely to be treated faster at urgent/walk-in care. Check table 1 for some common conditions treated in urgent care/walk-in centers or emergency departments. Visit the intranet for a more inclusive list.
Keep in mind that your copay varies by care site. Table 2 outlines the copays for YNHHS Medical Plan members.
Table 1
Common conditions treated in urgent/walk-in care centers and emergency departments:
| Condition |
Urgent Care/ |
Emergency |
|---|---|---|
| Abdominal pain (severe) | X | |
| Allergic reactions (severe) | X | |
| Allergy symptoms (seasonal) | X | |
| Bleeding (severe) | X | |
| Broken bones, fractures | X | X |
| Burns (minor) | X | |
| Burns (severe) | X | |
| Cold/flu/bronchitis/asthma | X | |
| Diarrhea/constipation | X | |
| Difficulty breathing | X | |
| Ear/sinus infections | X | |
| Eye injuries (minor) | X | |
| Fever | X | |
| Headaches | X | |
| Heart attack/chest pain | X | |
| Insect bites and rashes | X | |
| Lacerations/stitches (moderate) | X | |
| Lacerations/stitches (severe) | X | |
| Loss of limb | X | |
| Nausea/vomiting | X | |
| Severe head trauma | X | |
| Slurred speech | X | |
| Sore throat/strep throat | X | |
| Sprains and strains | X | |
| Stroke | X | |
| Urinary tract infections | X |
Table 2
YNHHS Medical Plan Benefit Design
| Signature Facility/Provider | Anthem PPO Provider | Out-of-Network Provider | |
|---|---|---|---|
|
Emergency Department |
$250 copay | $250 copay | $250 copay |
|
Urgent Care facility and walk-in medical center |
$25 copay | $50 copay | $50 copay |
|
Ambulance |
N/A | 0% | 0% |
|
Telehealth (OnDemand and LiveHealth Online only) |
0%, $0 copay | $30 copay | Not covered |
|
Primary care visit (in-person or electronic) |
$10 copay | $30 copay |
50% of maximum allowable amount after deductible |
|
Specialist office visit (in-person or electronic) [1] |
$25 copay | $50 copay |
50% of maximum allowable amount after deductible |
[1] Tests (e.g., some lab work) associated with office visits may be subject to a copay or deductible and coinsurance if they are not mandated by the ACA. Check with your provider or call Anthem to determine if a specific test is covered at 100 percent.
[2] Find a list of Tier 1 Signature Network providers via HRConnect, 844-543-2147 (844-543-21HR).
It’s good to know how the ED or urgent/walk-in care can best help you, but don’t ever delay getting help for a life- or limb-threatening emergency situation. Call 911 immediately or go to your local emergency department.
