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When should I choose my primary care doctor (PCP), urgent care or the ER?

If it's not an emergency, your primary care doctor should be your first choice when seeking care. Your PCP can treat common illnesses (cold, flu, sore throat, etc.) and minor injuries and conduct routine exams, vaccinations and screenings.

If you get your health plan through your employer, check with your primary care doctor, behavioral health provider or specialist to see if they offer virtual care. And, be sure to check your cost share. With a virtual visit, you may be able to get care wherever you are for as low as a $0 copay. If your doctor isn’t available, you may be able to use Teladoc, the nation’s largest virtual health care company. Check with human resources to verify your plan’s benefits.

If you buy your own plan for you and your family, virtual visits with designated primary care doctors and 24/7 care with Teladoc are available for a $0 out-of-pocket cost with most plans. Ask your doctor if they offer virtual visits.

To contact Teladoc, you can download the mobile app or call 800-TELADOC.

If you need care right away, use this guide to help decide where to go:

Urgent care centers are less expensive than ERs and often have shorter wait times. Many times, an urgent care center can also provide any necessary labs or X-rays as part of your treatment. Visit an urgent care center for conditions like:

  • Cold and flu-like symptoms
  • Migraines
  • Sinus infection
  • Urinary tract infection
  • Upper respiratory infections
  • Low back pain, strains, sprains and/or breaks
  • Mild burns

To find an in-network urgent care center (UCC) near you, click here.  For a broader list of UCCs, which includes out-of-network options, click here

 In a life-threatening emergency, always call 911 or go to the nearest ER. Examples of symptoms that require ER care include:

  • Severe chest pain (a possible heart attack)
  • Signs of a possible stroke
  • Severe or sudden shortness of breath
  • Sudden or unexplained loss of consciousness

 

Going to an ER for nonemergent services can be very costly.  You could save on medical costs by choosing to go to an Urgent Care Center (UCC).

Example 1:

Going to an Urgent Care (UCC) for treatment of a Sprained Ankle

  • You Pay - $55*
  • Florida Blue Covers - $103*

Going to an ER for treatment of a Sprained Ankle

  • You Pay - $626*
  • Florida Blue Covers - $1,093*

Note: ER cost includes Facility Fees

 

Example 2:

Going to an Urgent Care (UCC) for treatment of Flu Symptoms

  • You Pay - $59*
  • Florida Blue Covers - $99*

Going to an ER for treatment of Flu Symptoms

  • You Pay - $765*
  • Florida Blue Covers - $1,367*

Note: ER cost includes Facility Fees

 

What’s a Value Choice Provider?

As a Florida Blue member, you may save time and money when you see a primary care doctor at any Sanitas Medical Center or Diagnostic Clinic Medical Group location. These Value Choice Providers offer you quality care — under one roof — for many conditions. And with more convenient hours, it’s easier to find time to go to the doctor.

 You'll save time with on-site diagnostic tests at many locations, and you can request a Spanish-speaking doctor.

They offer urgent care and same-day appointments on your schedule — most locations are open late and on weekends. And best of all, if you choose a doctor at Sanitas or Diagnostic Clinic Medical Group as your primary care doctor, you could have appointments for as low as a $0 copay per visit. (This doesn't apply if you have a Health Savings Account plan.)

To find a location near you, visit www.mysanitas.com or www.dc-fl.com.

 

 

*These are examples based on averages of all claims from in-network providers for commercial Florida Blue products in the year 2020 and are not specific to any plan.  Members should refer to their plan benefits for more details regarding appropriate member liability for specific services.

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