Written by Nick Ebert, Alyssa Orcuilo, and Khang Vuong
When someone has ailments like a flu or cold, it is much more affordable to go to an urgent care clinic as opposed to the emergency room. Because of the high cost of operations (24/7 staffing, expensive equipment, etc), a simple trip to the emegerncy room could easily cost over $500, with or without insurance:
Emergency Room Cost
Upper Respiratory Infection
Urinary Tract Infection
While urgent care can help you save hundreds of dollars in medical costs and are more convenient, it is difficult to know how much an urgent care visit costs without insurance or with a high deductible health plan. Because of COVID-19 major insurance carriers are looking at increasing premiums from 4% to 40% which will drive even more people into becoming uninsured.
We surveyed 91 clinics in NYC, SF Bay Area, Los Angeles, Houston, Dallas, and Philadelphia and found that the average cost of an urgent care visit without insurance ranges from $80-280 for a level I visit and $140-440 for a level 2 visit. Here are the 7-step guide we put together to help you better navigate the system and save
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1. Determine If You Need A Level I Or A Level II Visit
At most urgent care clinics, there are different levels of service, each with more services and higher cost. For example, the treatment for a strep throat requires the basic examination visit cost and a fee for extra services like a strep test (this usually adds $30-$40). For conditions that require extra procedures like X-rays, the cost could be much higher, in the neighborhood of $250-$500.
When looking at the cost of urgent care clinics, it is important to locate which level (I or II) you need so that you know what price you will be paying.
As a rule of thumb, infectious diseases like flu, strep, and so on usually fall under basic visits while sports injuries that require X-rays or minor surgeries would fall under advanced visits.
2. The Average Cost For A Level I Urgent Care Visit Ranges from $80-$280
Half of urgent care clinics we surveyed used a fee-for-service pricing model and half used a bundle pricing model. Both have their pros and cons but bundle pricing tends to be better for the patient due to the certainty it brings.
On average, the cost of a level I urgent care visit varies as much as 3 times with the majority of urgent care clinics changing between $120 to $160. It is important for you to call and ask before hand due to the wide range of prices available sometimes within the same zipcode.
3. The Average Cost of A Level II Visit Ranges From $140-$440
For conditions that require additional procedures like sports injuries and minor wound, you can expect to pay $180 to $240 in total for such visits. We also found a wide range of prices varies as much as 3 times.
On top of that, not all clinics are capable of providing X-rays or have a physician on staff to carry out minor surgeries. For those with bundle pricing, only 56% of clinics with such pricing model include X-rays in the service.
It is important for you to call and ask if the clinic is capable to provide the service you need and if there is any extra cost associated with the procedure. X-rays for example, often require reading from an external radiologist which could be costly.
4. Price Differences Across Big Cities
Based on data from 91 urgent care clinics in the six major metropolitans (NYC, Philadelphia, LA, SF Bay Area, Dallas, and Houston), the cost for urgent care without insurance will depend on where you live.
The lowest average price for a level I visit in New York City is $161 while the highest average price for a basic visit is $225 in San Francisco Bay Area.
Within New York City, we were also very suprised that The Bronx has the highest price for uninsured patients while Forest Hills, a residential neighborhood in Queens, NY, has the lowest price.
5. How Do I Save Money At Urgent Care If I Don't Have Insurance?
Look up "self-pay" rates: fortunately, websites like Healthcare Bluebook and SolvHealth allow you to get an estimate of how much your urgent care visit is going to cost. Self-pay rate aka cash rate is the charge set by clinics for patients without insurance.
Call a head of time: it is always smart to call ahead of time, not only to check for available time slots but also to better understand how the urgent care clinic charges patients without insurance.
Ask the right questions: ask if the clinic has separate charges for the office visit and in-house lab tests or if they have a bundle price. For latter, make sure you ask if the bundle price also includes options like X-rays and minor wound repair.
Be patient and be nice: receptionists at urgent care clinics have to deal with a very high call volume every day and they also juggle many different tasks to keep the clinic running. These professionals are truly there to help you, show some appreciations for what they do and kindly explain to them your situation, they can be much more helpful than you think!
6. What If I Have A High Deductible Health Plan?
If you happen to be covered under a high deductible health plan, instead of paying the self-pay rates, you will be paying what your insurance company negotiated with the provider. This negotiated rate, more often than not, is 30-40% higher than the self-pay rate unless there is a copay.
Let say you have a $5000 deductible and have to pay 100% out-of-pocket until meeting your limit, a level I urgent care visit could cost you anywhere from $180-$300 instead of a $130 for self-pay patients.
The good news is under the HITECH Act, "individuals can restrict disclosures to their health plan for services for which they pay 'out of pocket' and in full." This means you can elect to opt-out of your insurance benefit for certain medical services which you decide to pay out-of-pocket for. While we suggest to consult with your insurance carrier always, it is also smart to shop around and ask for the best rate then choose accordingly.
7. Alternative Options
Urgent care clinics are not the only way for people without insurance to get care. There are emerging virtual visit services that can provide a basic consult for less than a traditional visit (CVS online visits and Virtuwell visits are both around $50). However, because of the limited scope of virtual visits, doctors aren't able to prescribe tests to better diagnose you for certain conditions like Flu, strep, or UTI.
For folks who value pricing transparency and affordability, Mira is a great option for you to get preventative, urgent care, and more - for only $25 a month and a $99 fixed copay regardless of visit reasons. Mira has over 100 partner clinics nationwide and covers a comprehensive list of conditions from flu, strep, UTI, to getting an X-rays and EKG.
Signing up for Mira is extremely easy and quick. You can use Mira both as a stand alone benefit or add Mira on top of your high deductible plan.
There is a significant level of uncertainties when it comes to shopping for an urgent care visit while not having insurance or with a high deductible.
The costs for an individual without insurance range anywhere from $80-$280 for a basic Level I visit and $140-$440 for an advanced Level II visit. Pricing also varies up to 3 times depending on the location.
Whether it be for a fever, a sore throat, or even a sports injury, urgent care is still a superb option in term of affordability and convenience compared ot the emergency room. Don't be afraid to ask questions because receptionists at urgent care clinics are generally knowledgeable and are there to help you.