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Urgent Care

Urgent Care Centers offer walk-in care for patients with illnesses or injuries that do not require the intensity of care offered at an emergency room, but typically cannot wait for a scheduled appointment in a physician's office. Examples of some urgent (non-emergency) illnesses include: sprains, ear infections, and non-emergency allergic reactions.


If you have an urgent health situation, you may want to contact your family doctor. Typically they have an on-call doctor who is available 24 hours a day.


You may also call the BlueHealthConnection® Program 800-775-BLUE (2583) for nurse support.


If you use an Urgent Care Center, please consider the following — There are two different types of Urgent Care Centers:


Hospital-owned Urgent Care Center Freestanding Urgent Care Center
Definition
  • Facility is located on or off the hospital campus and is fully owned by a licensed acute-care hospital
  • Does not necessarily operate 24 hours a day/7 days a week
  • Provides medically necessary services for the treatment of illness and injuries that have the potential to develop into further disability or death if treatment is delayed longer than 24 hours.
  • Facility is not owned by a hospital
  • Provides medically necessary services for the treatment of illness and injuries that have the potential to develop into further disability or death if treatment is delayed longer than 24 hours
  • BCBSM treats freestanding Urgent Care Centers just like a physician office visit.
Provider is considered in network
A hospital-owned Urgent Care Center, if that hospital participates with BCBSM and bills your visit as an urgent care visit At freestanding Urgent Care Centers, if the billing doctor is a BCBSM participating physician who is part of your particular health plan's network
Notes
Depending on your particular health plan, you may have copayment or other out-of-pocket charges in the outpatient hospital setting. Please refer to your specific benefit plan description for more details about hospital outpatient coverage. BCBSM currently treats freestanding Urgent Care Centers like a physician office setting. Office visit benefits will apply to the free-standing urgent care setting, including copays and deductibles for in- and out-of-network services. Please refer to your specific benefit plan description for details about your office visit coverage.


Frequently Asked Questions about Urgent Care

If I have an earache or other non-emergent condition and I go to an emergency room, what will happen?

If you have a non-emergent service done at an ER you may incur ER copays and other forms of cost-sharing that are typically higher than when you seek services in a physician office or Urgent Care Center. In some cases, your benefits may limit the conditions that are considered emergency, which may affect how much you will have to pay for the service.

How do I figure out if my visit to the Urgent Care Center will be covered?

If you go to a freestanding Urgent Care Center, make sure that the billing doctor participates with BCBSM as part of your particular health plan network. If you go to a hospital urgent care setting, make sure the hospital participates with BCBSM. BCBSM has billing rules in place to help ensure that participating hospital Urgent Care Centers bill appropriately for urgent care services. This does not guarantee coverage but if you have coverage, this will protect you from having to pay for more than your copays and deductibles.

What will happen if I go to a freestanding Urgent Care Center and I do not see a participating BCBSM provider who is part of my health plan network?

If you see a provider who does not participate in your BCBSM health plan network, you may incur higher out-of-pocket cost sharing for seeing an out-of-network physician. Please refer to your specific health plan benefit description for more information.

Are Urgent Care Centers the same as a doctor's office?

Unlike the primary care physician office setting, urgent care facilities focus on acute, episodic care, emphasize unscheduled care, and offer extended evening and weekend hours. Additionally, these facilities generally provide a wider and more complex scope of services than the physician office setting.

How can I find a participating freestanding Urgent Care Center?

You can check your local Yellow Pages for Urgent Care Centers. You may call the center to verify that their doctors participate with BCBSM in your benefit plan.

How do I find a PPO doctor's office that offers after-hours care?

BCBSM's Web site lists PPO doctor's offices that offer after-hours office appointments. Click on Find a Doctor and then choose a PPO plan and choose "show me only after hour care providers."

Blue Care Network of Michigan

Blue Care Network members should visit MiBCN.com for a list of BCN Urgent Care Centers.