Understanding your insurance coverage before visiting an urgent care facility can prevent unexpected bills and help you make informed healthcare decisions for your child.

How Insurance Typically Works for Urgent Care

In-Network vs. Out-of-Network

In-Network: Facilities that have contracted rates with your insurance company. You'll pay less for services at these locations.

Out-of-Network: Facilities without contracts with your insurer. These typically cost more and may require you to pay upfront and file for reimbursement.

Common Cost Components

• Copay: Fixed amount you pay at the visit (typically $50-100 for urgent care)
• Deductible: Amount you must pay before insurance coverage kicks in
• Coinsurance: Percentage of costs you pay after meeting your deductible
• Out-of-Pocket Maximum: The most you'll pay in a year before insurance covers 100%

Types of Insurance Plans

Health Maintenance Organization (HMO)

• Usually requires staying in-network
• May need referrals for specialists
• Lower premiums but less flexibility
• Urgent care typically covered without referral

Preferred Provider Organization (PPO)

• More flexibility to see out-of-network providers
• No referrals required
• Higher premiums but greater choice
• Lower costs when using in-network facilities

Exclusive Provider Organization (EPO)

• Must use network providers except in emergencies
• No referrals needed
• Moderate premiums

High Deductible Health Plan (HDHP)

• Lower premiums, higher deductibles
• Often paired with Health Savings Account (HSA)
• You pay full cost until deductible is met

TennCare (Tennessee Medicaid)

TennCare provides healthcare coverage for eligible low-income Tennessee residents. Coverage includes:

• Doctor visits and urgent care
• Emergency room visits
• Prescriptions
• Hospital stays

Important: Not all urgent care facilities accept TennCare. Always call ahead to verify acceptance before your visit.

Before Your Visit

Check Your Benefits

• Review your insurance card for urgent care copay information
• Call your insurance company to verify coverage
• Ask about your deductible status
• Understand your out-of-pocket maximum

Verify the Facility is In-Network

• Check your insurance company's provider directory online
• Call the urgent care facility to confirm they accept your insurance
• Ask if they can verify benefits before your visit

Questions to Ask Your Insurance Company

• What is my urgent care copay?
• Have I met my deductible?
• Is [facility name] in-network?
• What services are covered?
• Are X-rays and lab tests covered?
• Do I need pre-authorization?

Typical Costs

With Insurance (In-Network)

• Copay: $50-100
• Additional procedures may have separate costs
• X-rays: $50-150 out-of-pocket
• Lab tests: Varies by test

Without Insurance (Self-Pay)

• Visit: $100-250
• X-rays: $100-300
• Lab tests: $50-200
• Simple procedures: $100-500

Out-of-Network

Costs vary significantly. You may need to:

• Pay the full amount upfront
• Submit claims for reimbursement
• Meet a higher deductible
• Pay higher coinsurance percentages

What Services Are Usually Covered?

Typically Covered:

• Medical examination
• X-rays for injuries
• Basic lab tests
• Prescriptions (subject to pharmacy copay)
• Simple procedures (stitches, splints)

May Not Be Covered or Have Additional Costs:

• Cosmetic procedures
• Pre-existing condition care (in some plans)
• Certain preventive services
• Some specialized tests

Billing and Payment

At the Time of Visit

• You'll typically pay your copay when you check in
• Additional charges may be billed later
• Self-pay patients may need to pay in full

After Your Visit

• The facility submits claims to your insurance
• Insurance processes and pays their portion
• You receive an Explanation of Benefits (EOB)
• You're billed for remaining balance

If You Can't Afford Care

Options to Consider:

• Payment plans: Many facilities offer interest-free payment plans
• Financial assistance: Some facilities have charity care programs
• Community health centers: Sliding scale fees based on income
• TennCare eligibility: Check if you qualify for state assistance

Dealing with Unexpected Bills

If You Receive an Unexpected Bill:

• Review your EOB carefully
• Call your insurance company to understand the charges
• Contact the urgent care facility's billing department
• Ask about billing errors
• Request an itemized bill
• Negotiate if paying out-of-pocket

Tips for Managing Costs

• Always use in-network facilities when possible
• Ask about costs before agreeing to additional tests
• Keep all receipts and documentation
• Set up a Health Savings Account (HSA) if eligible
• Consider urgent care over ER when appropriate to save money
• Ask about self-pay discounts if you don't have insurance

Common Insurance Plans in Tennessee

Major insurers operating in Tennessee include:

• BlueCross BlueShield of Tennessee
• Cigna
• Aetna
• UnitedHealthcare
• Humana
• TennCare (Medicaid)

Use our directory to find urgent care facilities in Tennessee that accept your insurance. Many listings include accepted insurance information, and you can always call ahead to verify coverage.