Employers guide to Helping Employees Seek Proper Medical Care Utilizing Health Insurance Coverage
By: Mary Thompson Capstone Brokerage President September 18, 2014
Here in Las Vegas it may still seem like summer with record temperatures and high humidity. The fact of the matter is fall/winter should be upon us. The colder months will bring cold and Flu season, and a very busy time for doctors across the valley, making getting in to your primary care physician the same day more difficult. So what are your treatment options if you aren’t feeling well?
There are essentially 5 different treatments options when facing medical issues as a result of the common cold or other severe situations.
1. Primary Care Physician – This is the best option for a common cold or Flu. One main reason it is beneficial to seek medical attention from a primary care physician is that often it is the most cost effective option for the consumer. Primary Care Physicians also know their patients history. The one big downside is sometimes you can’t get in for care on a short notice. Also there are limited hours and most are closed evenings and weekends.
2. Convenient clinics or healthcare clinics – These clinics are often found in stores such as Walmart and CVS. They are a great alternative when your primary Care Physician simply can’t get you in or isn’t open. They can treat minor aliments such as sore throat, allergies, or sprains. They are often staffed by Physicians assistants, have longer hours and are open on the weekend. Typically the cost of visiting this type of care facility is minimal. It is important however that you still make sure that they are contracted as in-network with your insurance provider. (Note: NOT all clinics will be covered under every insurance policy).
3. Quick care or Urgent Care Clinics- They can treat more serious illnesses and injuries, and are designed to take some of the burden off more expensive hospital emergency care services. Extended hours and weekend services are usually available. Urgent care clinics are staffed by physicians, can provide x-rays, administer IVs and treat minor and moderately severe trauma for non-life-threatening conditions such as broken bones or deep lacerations. The cost for the consumer is still less then a hospital and may prove to be the best option for broken bones, burns and dehydration. (Note: A key to remember is that urgent care is not emergency care. If the situation seems life threatening, a hospital ER is always the first choice.
4. Emergency Room(ER) – Most hospitals have an ER. The ER is an essential part of our healthcare system. An Emergency room is there to provide fast life saving care. Emergency rooms are the best place for treating severe and life-threatening conditions. They’re open 24 hours, seven days a week. They have the widest range of services for emergency after-hours care, including diagnostic tests and access to specialists. Although typically the ER has the highest co-pay it is the ONLY option when presented with a life threatening situations such as persistent chest pain, shortness of breath, weakness and paralysis, etc.
5. 911 and calling for Paramedics – The last treatment option is often used only in emergency situations. Calling 911 is necessary if you require immediate help. If a life threating event is taking place, medical attention during transportation to a hospital is the safest choice. Certain medical emergencies require life-saving measures in route to a hospital such as a heart attack or stroke. There are also situations that the patient may need to be treated prior to transport, such as in a fall. 911 is always there and the paramedics can be dispatched to most locations in a matter of minutes.
Many employers in the past educated their staff on how to use their health insurance coverage to keep premium increases down and employee out-of-pocket expenses low. With the passing of the Affordable Care Act health insurance and the medical underwriting process has drastically changed. Age rating no longer allows for usage based increases in premium but it is still smart to educate your employees about care options that are available to them. Perhaps the most important tool to arm employees with is understanding the difference in where to seek treatments. This winter remember to wash your hands properly and stay healthy.
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