Frequently Asked Questions - Convenience Care/Urgent Care

What's the difference between an ER and a convenience care/urgent care facility?
A hospital Emergency Room is for acute emergency situations. Convenience care/urgent care facilities are generally satellite facilities and are for non-life threatening injuries and illnesses. A convenience care visit is covered as an office visit. Under the PPO, CDHP and EPO plan options, you must pay an extra fee (in addition to your deductible or co-insurance amount) for an ER visit, unless you are admitted to the hospital as an in-patient. Admission to an Observation Room will not waive the ER fee.


If I go to a convenience care facility and they send me to the ER, will the ER fee be waived there?

No. You can use convenience care if you do not need ER or hospital assistance. However, if the convenience care provider sends you to the ER, you will still be charged the ER fee if you are not admitted to the hospital as an in-patient.


Can I use the convenience care facility located inside the main hospital 24 hours a day?
Some hospitals have a convenience care facility on-site, and some hospitals have a minor emergency area located in the ER. These treatment areas inside a hospital are considered minor emergency treatment areas. The ER staff may triage the less serious cases to these kinds of areas; however, almost all hospitals bill these services as ER codes, and the ER fee would apply. There are some exceptions, and you may wish to investigate this before an urgent need arises by calling your local network hospital. The ER fee does not apply for off-site convenience care or urgent care facilities.


Can employees use any convenience care, even if it is not in-network?
Employees can go anywhere they would like for care. But, in order to be covered at the maximum benefit (or to be covered AT ALL on the BCBS National EPO option), network providers should be used. Remember, use of a non-network provider for life-threatening situations is not subject to network requirements.