Two challenges people routinely face when it comes to healthcare is 1) where is the right place to go depending on my condition, and 2) what is covered by my insurance?

The worst time to look for answers to these questions are evenings and weekends when some locations may be closed or when you are feeling ill or facing an emergency situation. It is for this reason that spending a little time reviewing your provider options and health insurance coverage in advance will serve you well.

Each year at the time of open enrollment, health insurance plans come with Benefits Guides that provide detailed information about deductibles, copays, out-of-pocket maximums, in-network and out-of-network coverage, and other important information. It should also advise if a plan has a telehealth/telemedicine option; if dental and vision plans are included in your health insurance coverage; and what is included, excluded, or an added cost.

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It’s a terrible feeling to think a particular service is covered only to find out later that limits and restrictions may apply; hence, take the time to review your coverage and keep your benefits guide summary handy when scheduling routine appointments or in an emergency situation.

Primary care visits for adults and children is the best source of care for routine wellness visits, chronic care and non-life threatening conditions. Primary care visits are also appropriate when a person is feeling ill and needs a diagnosis and course of treatment.

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At times it can be difficult to see a primary care physician on short notice; in such an instance, visiting a Rapid Care (walk-in primary care) or Urgent Care (lower acuity emergency care) facility is a good alternative. Telehealth/telemedicine can also provide convenient care at any time — weekdays, evenings and weekends, at home or away from home.

For these visits to be most successful, it’s advisable to set-up a telemedicine account in advance, so you’re not left scrambling when you need to use the service. (Again, you’ll want to verify in advance that telehealth/telemedicine is available through your insurance plan.) The emergency department is great for, you guessed it, emergencies; but it is not a great option for routine and preventative care, as receiving treatment at an emergency facility results in the highest cost care.

Understanding where to go for care can affect how much you pay, how long you wait, and the treatment you receive. Cost is typically determined based on the type of facility you visit — not just your injury or condition. Your primary care provider or rapid care will usually be the lowest-cost option, followed by urgent care. The emergency department is the highest cost option.

For people without health insurance, Memorial Regional Health has financial counselors to assist with sliding scale and payment plans to ensure people can still receive affordable health care. Additionally, MRH’s financial counselors and care coordination team can help connect people to resources to determine if they’re eligible for Medicaid or insurance on the open market. Contact MRH’s Care Coordination team at 970-826-8010 for more information. 

Again, understanding your provider options and health care coverage can help you be proactive in caring for your health, in both routine and emergency situations. Be prepared by keeping your benefits summary in a place that is readily accessible by all family members when scheduling health care appointments or in case of an emergency.