Save a Trip to The Emergency Room When Possible
Have you ever been in a situation where you, a co-worker, or an employee is injured or becomes ill on the job and panic settles in, leading to an emergency room (ER) visit for a minor issue? If so, you are not alone. The National Hospital Ambulatory Medical Care Survey estimates that between one-third and half of all ER visits are for non-urgent care.
In 2022, the Fund Workers’ Compensation program paid more than $5 million for emergency care, urgent care, and ambulance services. If you choose the right treatment avenue, you can reduce costs for your organization and improve the chances of a claim being approved.
For an extreme, potentially life-threatening medical condition such as chest pain or severe burns, going to the local hospital emergency room is the best choice. Urgent care centers are better suited for conditions that are not life-threatening but that need to be treated the same day. Minor conditions that are not potentially life-threatening should be examined at a primary care facility, occupational health clinic, or through a telemedicine visit.
While there could be crossover between minor conditions that justify an urgent care visit, telemedicine visit, or doctor visit, symptoms can help you make the most appropriate choice.
When to Think ER
Consider a trip to the ER for severe conditions such as a potential heart attack or stroke and severe bleeding that cannot be stopped. Other reasons to go to the ER include severe burns, severe pain, a fever higher than 104 degrees Fahrenheit, paralysis, and/or shortness of breath that persists. An ambulance ride to the ER should be used only for potentially life-threatening situations such as severe chest pain and loss of consciousness.
Estimated cost for ER visit: $2,000-$5,000 for the facility and $300-$500 for the physician; an extra $800-$1,500 for a ground ambulance; and $10,000-$45,000 for an air ambulance. There may be a separate charge for X-rays and lab testing.
What Defines a High Blood Pressure Emergency?
High blood pressure, also known as hypertension, is one condition that is often directed to the ER unnecessarily. Normal blood pressure is defined as 120/80, and high blood pressure for adults is defined as 130/80 or higher. When someone has high blood pressure, check for chest pain, shortness of breath, and other potentially life-threatening symptoms that justify an ER visit.
Symptoms can help distinguish between high blood pressure hypertensive urgency and a hypertensive emergency:
- Hypertensive urgency: If your blood pressure is 180/120 or higher, wait about five minutes and check again. If the second reading is just as high and you do not have other symptoms such as chest pain, shortness of breath, back pain, changes in vision, or difficulty speaking, an ER visit is likely not warranted. Seek help from a non-urgent medical provider, who might add to or adjust your medications.
- Hypertensive emergency: If your blood pressure is 180/120 or higher and you are experiencing symptoms listed above at the same time, call 9-1-1 or go to the ER.
- Other reasons to see a doctor for high blood pressure: If you have high blood pressure less than 180/120, contact a clinic, primary care doctor, or urgent care.
When to Think Urgent Care Center
Symptoms appropriate for an urgent care center visit include fevers below 104 degrees Fahrenheit, possible respiratory or urinary tract infections, breathing discomfort, bites, sprains, minor burns, minor pain, possible minor broken bones, and cuts and bleeding that may require stitching.
Estimated cost for urgent care center visit: $300-$500; There may be a separate charge for X-rays and lab testing.
When to Think Doctor Visit or Occupational Health Clinic
Contact a primary care office or occupational health clinic for fevers, flu, cold symptoms, ear infections, animal or insect bites, seasonal allergies, bronchitis, sprains or possible minor broken bones, vomiting, diarrhea, breathing discomfort, urinary tract infections, X-rays or basic lab tests, minor abdominal pain, minor back or limb pain, and cuts and bleeding that may require stitching.
Estimated cost for doctor/occupation health clinic visit: $90-$400 (for a new condition). There may be a separate charge for X-rays and lab testing.
When to Think Telemedicine
Consider a workers’ compensation telemedicine visit to avoid travel costs for minor conditions or injuries such as bites; slips, trips, and falls; bruises, scrapes, and cuts; skin conditions; minor wounds or burns; cold symptoms; allergy symptoms; and stress.
Estimated cost for telemedicine visit: $90-$210. There may be a separate charge for X-rays and lab testing.
Selecting Appropriate Care Can Save Money
There is some overlap in medical conditions between the options above. To choose the best route for each situation, consider medical urgency, additional symptoms, the person’s medical history, and costs. While it can be stressful when you or a co-worker are injured or ill, it is important to remain calm and work through the decision-making process.
The costs that come with unnecessary ER visits can impact your organization’s coverage contributions. Use our guidance to ensure employees receive appropriate care for work-related injuries and illnesses:
- An ER visit is appropriate for potentially life-threatening conditions.
- If the employee just needs same-day treatment, consider an urgent care center.
- For non-urgent care, an outpatient doctor’s visit or telemedicine visit are the best choices.
Get Treated by Top-Notch Providers in Network
The Fund is part of the Political Subdivision Workers’ Compensation Alliance (Alliance). The Alliance maintains a network of high-quality medical providers for injured employees and negotiates rates to provide cost savings to members with Workers’ Compensation coverage. However, the Alliance cannot contract directly with hospital-based ER or free-standing ER facilities.
The Alliance has frequently been recognized as a high performer in the annual Texas Department of Insurance Network Report Card. Contact the TASB Workers’ Compensation team at 800-482-7276 with questions about your claims.
Editor's note: This article was originally published in December 2019. It has been updated for accuracy and comprehensiveness.
Dr. Brian Buck
Dr. Brian Buck serves as TASB Medical Director in the Workers’ Compensation division, providing medical expertise to support claims decisions.