Navigating Health Care: Navigating Urgent
or Emergency Care
Debra: There’s a good chance that someday you’ll need to go to a hospital
emergency department. But you shouldn’t wait for an emergency to learn how to
seek urgent or emergency care. AHRQ Director Dr. Carolyn Clancy is with us with
her tips for navigating through a health care emergency. Dr. Clancy, welcome.
Debra: What do people need to think about before deciding to go to an emergency
Dr. Clancy: In cases where you are having a true
medical emergency - you think you are having a heart attack or you’ve broken a
limb - you should just go to the nearest hospital as fast as possible or call an
ambulance. But sometimes deciding if your issue is a real emergency is a
judgment call. It’s very helpful to know ahead of time how to reach your
clinician’s office after hours or if your health plan supports a nurse call line
for advice. It’s also important for you to know what kinds of medical problems,
conditions, or injuries are defined by your health care plan as emergencies.
Debra: So, I know that my plan includes my issues
as a true medical emergency and, therefore, I go to the emergency department. Do
I need to call my health plan provider afterwards to let them know I went to the
Dr. Clancy: Most plans do require notification
within a certain time after emergency - especially if you’re admitted to the
hospital. Also, if you are admitted, keep in mind that if the hospital you go to
is not part of the plan network, you may be transferred to a network hospital
when your condition is stable.
Debra: What if I am traveling out of the area for
work or vacation? How to I get urgent care or hospital care then?
Dr. Clancy: Again, if it’s a true emergency, seek
care immediately. However, the rules for where to seek care and what qualifies
as an emergency can vary from plan to plan. The best answer is to call your
health plan before you travel. Most health insurance cards have a number on the
back. Ask them for information and take it with you on your trip.
Debra: Well, what about if I need urgent care,
but it’s definitely not an emergency? Or, say I can’t get into my primary
clinician’s office for an appointment or my issue occurs after normal business
hours? What should you do?
Dr. Clancy: There are urgent care clinics. Some
people also call these retail medical clinics. You need to check with your plan
to find out what it considers as urgent care. Generally speaking, urgent care is
for problems that are not true emergencies, but still need quick medical
attention. Examples may include sore throats with fever, ear infections and
serious sprains. If you are having a tough time deciding if it is urgent, call
your primary care clinician’s office and ask for advice.
Debra: What if I don’t have a primary care
clinician? What if I’m using an urgent care clinic or the emergency room to get
my primary care?
Dr. Clancy: We’re seeing this trend more and
more, especially among the uninsured and within low-income communities. In fact,
an AHRQ report from 2005 showed children from poor families are almost twice as
likely as higher-income kids to use hospital emergency rooms. AHRQ data shows
most children use the ER for non-serious problems such as asthma, bronchitis,
ear infections, or bruises, cuts, scrapes, sprains and strains and Medicaid paid
for the majority of this care. In cases where a person is using urgent care
clinics or emergency rooms for primary care, my advice is to create a personal
health record. This can be a binder or a folder that includes records of
treatments, medication lists, lab results, X-ray results and so forth. Actually,
personal health records are a good idea for everyone, but they are especially
important for people who do not have a primary care provider.
Debra: Any last advice for navigating through a medical emergency?
Dr. Clancy: I urge consumers to get information they need. Ask questions and
investigate your options. Find out what your health plan covers and, in some
cases, doesn’t cover. Be prepared and, most importantly, take care of yourself.
An AHRQ publication can help. It’s called Questions and Answers About Health
Insurance, and it’s available for free on the AHRQ Web site at
I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care
Rand: That’s it for this week. For more information on these and other
health-related stories and topics, go to
Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research
and Quality, part of the U.S. Department of Health and Human Services. For Rand
Gardner, I’m Debra James. Please join us for the next edition of Healthcare 411.