Insurance Walk-Ins: What's Covered?

Walk-in clinics, also known as urgent care clinics, are an alternative to the emergency room for those who need immediate medical attention but do not have a serious or life-threatening issue. They are typically cheaper than an ER visit and provide similar care to that of a primary care physician. Walk-in clinics are usually open outside of traditional business hours and do not require appointments, making them a convenient option for those with minor illnesses or injuries. Many insurance plans cover walk-in clinic visits, but it's important to check the details of your specific plan to determine your coverage.

Walk-in clinics vs urgent care centres vs emergency rooms

The terms "walk-in clinic", "urgent care centre", and "emergency room" are often used interchangeably, but there are distinct differences between them. Understanding these differences can help patients choose the right healthcare provider for their needs, potentially saving time and money.

A walk-in clinic is a broad term for a healthcare provider that allows patients to be seen without an appointment. This could be an urgent care centre, a retail clinic, or an emergency room. Retail clinics are usually located within larger retail stores or pharmacies and are staffed by nurse practitioners or physician assistants. They focus on minor injuries and illnesses, immunizations, and health screenings, and some are expanding to include chronic disease management.

Urgent care centres are more advanced than retail clinics, often having at least one medical doctor on staff and equipped to handle more severe non-life-threatening conditions. They are often used to bridge the gap between primary care doctors and emergency rooms, offering shorter wait times and lower costs. Urgent care centres are typically open 7 days a week but are not always open 24 hours a day.

Emergency rooms are open 24 hours a day and specialize in life-threatening conditions and injuries. They are equipped with advanced technology and highly trained medical personnel and are required by law to accept all patients, regardless of their ability to pay. This often results in longer wait times and higher costs.

When deciding between a walk-in clinic, an urgent care centre, or an emergency room, it is important to consider the urgency of the situation, the staff available, and the cost of the visit. For life-threatening situations, it is always best to call 911. For non-life-threatening situations that require immediate attention, urgent care centres are a good option. For less serious conditions, walk-in clinics can provide convenient and affordable care.

When to choose a walk-in clinic

Walk-in clinics are a great option for those seeking quick, affordable, and convenient medical care for non-life-threatening conditions. Here are some scenarios when choosing a walk-in clinic is a suitable option:

• Non-Life-Threatening Conditions: If you are experiencing non-urgent medical issues, such as a cold, flu, sore throat, minor injuries (sprains, cuts, wounds), skin conditions (rashes, sunburns), or non-life-threatening allergic reactions, a walk-in clinic can provide timely treatment.
• No Appointment with a Family Doctor: If you don't have a family doctor or are unable to reach them, walk-in clinics offer easy access to medical professionals. You can often see a nurse or doctor without an appointment, making them a convenient option when you need immediate care.
• Extended Hours: Many walk-in clinics offer extended hours, including evenings and weekends. If your family doctor's office is closed or fully booked, walk-in clinics provide an alternative for after-hours care. This is especially useful for individuals with odd work hours or busy schedules who may not be able to visit their regular doctor during standard business hours.
• Avoid Emergency Room Costs: Walk-in clinics are significantly less expensive than visiting an emergency room for non-urgent issues. If you are facing high medical costs or want to avoid the financial burden of an ER visit, walk-in clinics offer a more affordable option for basic medical care.
• Convenience and Accessibility: Walk-in clinics are often conveniently located near retailers or pharmacies, making them easily accessible. They usually operate on a first-come, first-served basis, and some even offer online check-in options to add your name to the waitlist remotely.
• Short Wait Times: In many cases, walk-in clinics have shorter wait times compared to emergency rooms, especially for non-life-threatening conditions. If you are seeking quick treatment and don't want to spend hours waiting, walk-in clinics can be a faster alternative.

It is important to remember that walk-in clinics are not suitable for emergencies or life-threatening conditions. If you are experiencing severe symptoms or injuries, it is crucial to seek immediate emergency medical assistance or visit an emergency room.

When to choose an urgent care centre

Urgent care centres are ideal if you need treatment for a minor medical issue or if you require other medical services like lab work and vaccinations. They are also a good option if you don't have a primary care doctor or need care outside of your doctor's business hours.

• When you need care for a non-life-threatening condition: Urgent care centres are equipped to handle non-life-threatening conditions, such as minor illnesses or injuries. This includes things like suspected broken bones, cuts, bruises, stomach pain, vomiting, diarrhoea, skin infections, rashes, high temperatures, and mild to moderate cold symptoms. If you are experiencing mild symptoms, such as mild aches and pains or a mild cough, that could be caused by the flu, COVID-19, RSV or other viruses, rest, drink plenty of fluids, take over-the-counter medications, and monitor your symptoms. If your symptoms don't improve or worsen, consider calling your primary care physician or visiting an urgent care centre.
• When your regular doctor is unavailable or you can't get an appointment: Urgent care centres can provide treatment for issues that you would normally address with your primary care doctor. They are a good option if you become sick or injured and your regular doctor is not available or you can't wait for an appointment.
• When you need care outside of regular business hours: Urgent care centres often have extended hours and are open on weekends and holidays. This makes them a convenient option if you need medical attention outside of regular business hours.
• When you want to avoid long wait times: Urgent care centres often have shorter wait times than emergency rooms. If you need care but can wait a bit longer, calling ahead to ask about the estimated wait time can help you decide whether to visit an urgent care centre or go to the emergency room.
• When you need diagnostic services: Urgent care centres often have X-ray, lab, and other diagnostic services. This means they can handle more severe non-emergencies than walk-in clinics and free up emergency rooms for the most critical cases.
• When you need prescriptions or emergency contraception: Urgent treatment centres can organise prescriptions and provide emergency contraception if needed.

Remember, urgent care centres are not equipped to handle life-threatening emergencies. If you are experiencing a medical emergency, call 911 or your local emergency services or go to the nearest emergency room.

When to choose an emergency room

It is important to know when to choose an emergency room over an urgent care clinic or a walk-in clinic. While the answer is not always simple, knowing the difference between these options can make a huge difference, especially if you have a medical emergency.

Hospital emergency departments provide medical care at any time, day or night. They are equipped and staffed to handle the most complex or critical needs, including life- and limb-threatening situations ranging from heart attacks and strokes to traumatic injuries following a car accident.

• Severe physical trauma, such as that caused by a car accident.
• Suicidal or homicidal feelings.
• Loss of consciousness (fainting) if it happened due to an injury or caused an injury.
• Severe abdominal pain, especially with a fever.
• Sudden and severe headache: what people often describe as the worst headache of their life.
• Serious bleeding that doesn't stop after applying constant pressure for 10 minutes.
• Coughing up blood, blood in your vomit, or bright red blood from your rectum (that is not related to hemorrhoids).
• Sudden chest pain or the feeling of a heavy weight on your chest, which could indicate a heart attack. Other signs of a heart attack include pain in the left shoulder or arm, a burning sensation or aching under the breastbone, light-headedness, or jaw pain.
• Severe shortness of breath.
• Sudden numbness or weakness in the arms or legs and/or sudden onset of blurred vision, which could indicate a stroke. Other possible signs include disorientation and difficulty speaking.
• A very rapid pulse at rest without a fever that is not related to exercise or emotional stress.
• Poisoning. If you are unconscious from suspected poisoning, call 911 immediately.
• Wheezing, shortness of breath, or difficulty breathing.
• Displaced or open wound fractures.
• Bleeding that cannot be stopped.
• Fever with convulsions or any fever in children under three months.
• Confusion or changes in mental status.
• Coughing or vomiting blood.
• Severe headache or head injury, especially if the individual is on aspirin or blood thinners.
• Blood in the urine, or bloody diarrhea.
• Sudden inability to speak, see, walk or move.
• Chest pain or pressure.
• Compound fracture (bone that protrudes through the skin).
• Sudden change in vision.
• Uncontrolled bleeding.

If you are experiencing any of the above conditions, go to your closest emergency room or call an ambulance. It is always better to be safe than sorry. Trust your instincts and do not hesitate to seek emergency care if you feel that your condition is serious.

Cost of walk-in clinics, urgent care centres and emergency rooms

The cost of a visit to a walk-in clinic, urgent care centre, or emergency room will depend on several factors, including the type of facility, the patient's insurance coverage, and the severity of the medical condition. Here is a breakdown of the costs associated with each type of medical facility:

Walk-in Clinics:

Walk-in clinics are typically located within retail pharmacies and offer treatment for a wide range of common illnesses and health concerns. They are usually staffed by nurses, nurse practitioners, or physician's assistants and provide care without the need for an appointment. The cost of a walk-in clinic visit can vary depending on the patient's insurance status and the services required.

For residents of Ontario, Canada, covered under the Ontario Health Insurance Plan (OHIP), a visit to a walk-in clinic is typically free, except for prescribed medication. For those not covered by OHIP, the cost of a walk-in clinic visit can range from $50 to $150, depending on factors such as the patient's residency status and whether the visit occurs during peak times, such as holidays or weekends.

Urgent Care Centres:

Urgent care centres, also known as urgent treatment centres, provide medical care for non-life-threatening emergencies. They are usually staffed by nurses and, in some cases, physicians. Urgent care centres can diagnose and treat a range of common medical issues, including suspected broken bones, injuries, cuts, bruises, stomach issues, skin infections, rashes, and mental health concerns.

The cost of visiting an urgent care centre varies depending on insurance coverage. For those with insurance, the cost is typically similar to a doctor's visit copay. Without insurance, the cost of an urgent care visit can range from $100 to $200, with an average of around $150. The use of additional services, such as medical equipment for diagnosis and treatment, will incur extra costs.

Emergency Rooms:

Emergency rooms, also known as emergency departments, provide care for life-threatening emergencies and are typically attached to a hospital. They are open 24/7 and are required by law to treat anyone who comes in, regardless of their insurance status or ability to pay. Emergency rooms are equipped to handle severe medical issues, such as difficulty breathing, chest pain, seizures, head trauma, severe allergic reactions, and badly broken bones.

The cost of an emergency room visit can be significantly higher than that of a walk-in clinic or urgent care centre. For those with insurance, the copay for an emergency room visit is usually much higher than for other types of medical facilities. For those without insurance, the cost of an emergency room visit can be in the thousands of dollars, with average costs ranging from $2,199 to $2,259, according to a 2016 study.

In summary, the cost of seeking medical care will depend on the type of facility, the patient's insurance coverage, and the severity of the medical condition. Walk-in clinics and urgent care centres are typically more affordable options for non-life-threatening issues, while emergency rooms are significantly more expensive but are equipped to handle life-threatening emergencies.

Frequently asked questions