Frequently Asked Questions

General Questions

What is an emergency room vs. an urgent care?

An emergency room treats illnesses and injuries in need of immediate attention, some of which include chest pain, abdominal pain, dehydration, complex fractures and much more.

An urgent care typically treats acute and chronic illnesses and injuries that are non-life-threatening; some of which include common colds, flu, strep throat, lacerations and more.

Now that Medicare reimburses for urgent care, why doesn’t Medicare provide coverage for emergency services at Premier?

This is because Medicare only considers emergency services provided by locations licensed as a department of a hospital. As Premeir ER & Urgent Care operates independently and not as a department of a hospital, Medicare doesn't recognize our facilities as eligible to provide emergency services. However, Medicare doesn't require licensure as a hospital department to cover urgent care services, and we're glad to offer those to all Medicare-covered patients.

What is in-network vs. out-of-network?

For urgent care services at Premier ER & Urgent Care, in-network means we have a contract with your insurance company and have agreed on what the cost is for any service provided to you. Out-of-network means we do not have a contract with your insurance company in setting the rates. As a result, you may be billed a different rate as determined by your insurance company and benefit plan.

For emergency care at Premier ER & Urgent Care, state law says (states or requires) that all patients have to be treated regardless of their insurance plan or ability to pay. This means your insurance company should consider you in-network. We will bill you the amount defined by your insurance plan.

How does Premier ER & Urgent Care determine what to charge patients?

Your insurance company negotiates rates on your behalf with providers such as Premier ER & Urgent Care, and agrees upon the rates they feel are reflective of the value provided to their members. Factors involved include quality of providers, accessibility and patient experience.

What is the difference between my Explanation of Benefits (EOB) and my invoice from Premier ER & Urgent Care?

An Explanation of Benefits, or EOB, is something the insurance company sends to the patient to explain what is allowed by their policies and what the associated charges are. It is not a bill, but rather a communication from the insurance company to the patient. It may or may not correspond directly to what the final bill is from Premier ER & Urgent Care.

Visit our insurance and billing page for additional information.

What is a New Patient designation?

All health care insurance, including Medicare, set a distinction for first visits in an office or urgent care setting. The new patient charge is typically reimbursed at slightly higher rates than all following visits to the same location, due to the additional work required to set up new accounts and obtaining all the necessary details to make this happen. Established patients are those that have been seen at the office or urgent care in the past three years. The charge for an established patient visit is typically less than the new patient charge.

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