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Wednesday, August 27, 2008 9:00 AM
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 department?

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 hospital?

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 www.ahrq.gov/consumer. I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.


Rand: That’s it for this week. For more information on these and other health-related stories and topics, go to healthcare411.ahrq.gov.

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.


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