This article is intended for members enrolled in an individual health insurance plan.
Retail clinic. Urgent care clinic. Outpatient clinic. The type of clinic you go to can affect how long you wait, how much you pay out of pocket, and how your claim is paid.
These basic points may help you better understand your choices and what services different types of clinics may provide. This information can help you decide where to go when you need care and your doctor isn’t available.
Where are they? They can be found in stores like pharmacies, supermarkets and other retailers.
What are their hours likely to be? Retail clinics may have extended business hours beyond 8 to 5. Appointments may not be needed, but you may be able to make one or reserve a time.
What kind of providers may you see? Many retail clinics are staffed by physician assistants or nurse practitioners.
What can they do for you? Retail clinics provide a limited range of care, and they have set procedures. Some typical issues treated at retail clinics include sore throats, common colds, flu symptoms, coughs and sinus infections. They may provide screenings for cholesterol and blood sugar levels, vaccinations, and physicals required for sports participation.
If you visit a retail clinic, make sure you follow up with your doctor as soon as possible.
Urgent Care Clinics
Where are they? They can be found in office buildings or shopping malls or as part of a hospital. An urgent care clinic may have its own building.
What are their hours likely to be? Hours may range from early morning to late evening, five days a week. They also may provide weekend and holiday hours. Always check first. Appointments may not be needed, but you may be able to make one or reserve a time.
What kind of providers may you see? This type of clinic is primarily staffed by physician assistants and nurse practitioners. These clinics also may have radiology technicians.
What can they do for you? They provide convenient access to care for non-life-threatening health issues. They may be an option for those times when treatment is needed as soon as possible, and your primary care doctor is not available.
If you visit an urgent care clinic, make sure you follow up with your doctor as soon as possible.
Specialty or Outpatient Clinics
Where are they? Specialty clinics can be housed in an office complex. Sometimes they are near a hospital or medical group.
What are their hours likely to be? Specialty clinic hours are often typical business hours.
What kind of providers may you see? Specialty clinics are staffed by specialists in various fields. Nurse practitioners may assist with care, and technicians may draw blood or take X-rays when ordered by a doctor.
What can they do for you? Specialty clinics, or outpatient centers, provide common procedures that can be done in a clinical setting and don’t require an overnight stay. Examples may include common surgeries on eyes, hands or feet. Some tests like colonoscopies and scans can be done at this type of clinic as well.
It is important to note that specialty clinics are not for urgent situations. These clinics do require appointments. And some members in HMO plans may need a referral from their PCP for any care or procedures at a specialty clinic to be covered.
Before You Go
Before you go to any clinic, be sure to:
- Check the Provider Finder® tool to see if the clinic and providers are in your health plan’s network.
- Review the clinic’s hours to see when it’s open.
- Visit the clinic’s website. You may be able to get an idea of wait times or reserve a convenient time.
*Virtual Visits, powered by MDLIVE, may not be available on all plans. Check your carrier’s plan for details. Non-emergency medical service in Idaho, Montana and New Mexico are limited to interactive audio/video (video only), along with the ability to prescribe. Oklahoma may use video or audio. Virtual visits are not currently available in Arkansas. Service availability depends on the member’s location at the time of consultation. Virtual Visits are subject to the terms of your benefit coverage. This is a brief summary of some plan benefits. Please refer to your certificate of coverage for more complete details, including benefits, limitations and exclusions.
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