Know Before You Go
Choosing the right setting for your care—from vaccinations to X-rays—is key to getting the best treatment with the lowest out-of-pocket costs. It’s important to understand your options so you can make the best decision when you or your family members need care. The following information may help you decide where to go for medical treatment.
SmartShopper
You have a lot on your plate and the SmartShopper Personal Assistant Team is here to help. From MRIs to Sinus Surgery, they can research the in-network facilities, see where your doctor has privileges, and let you know what your out-of-pocket cost will be all in one easy call or email. They can even schedule your appointment and help you earn an incentive! Give them a call at 888-345-2873 and see how they can help.
When You Need Care
When your PCP isn’t available, being familiar with your options will help you locate the most appropriate and cost-effective medical care. The chart below shows how costs* may vary for a sample health plan depending on where you choose to get care.
Sample Cost |
Needs or Symptoms |
24/7 |
Rx |
|
|---|---|---|---|---|
| 24-Hour Nurse Advice Line | $0 | If you are unsure about your symptoms or where to go for care, call 800-535-9700, anytime day or night to speak to a registered nurse. | ||
| CloseKnit Virtual Care (24/7/365 virtual care for members) |
$0 |
|
||
| Convenience Care (e.g., CVS MinuteClinic or Walgreens Healthcare Clinic) |
$20 |
|
||
| Urgent Care (Non‑life threatening illness or injury requiring immediate care, e.g., Patient First or ExpressCare) |
$60 |
|
||
| Emergency Room (Life‑threatening illness or injury) |
$200 |
|
Primary care provider (PCP) $
The best place to get consistent, quality health care is your PCP. If you have a medical issue, having a doctor who knows your health history often makes it easier to get the care you need.
Free 24/7 nurse advice line $0
Call 800-535-9700 anytime to speak with a registered nurse. Nurses will discuss your symptoms and recommend the most appropriate care.
CloseKnit $0
An additional telehealth service called CloseKnit. CloseKnit will provide virtual only primary care services through a dedicated care team of physicians, nurse practitioners, physician assistants, licensed professional counselors and licensed clinical social workers.
Convenience care centers (retail health clinics) $
Also known as retail health clinics, these services are often located inside a pharmacy or retail store (like CVS MinuteClinic or Walgreens Healthcare Clinic) and offer accessible care with extended hours. Visit convenience care centers for minor concerns like colds and pink eye, strep tests and vaccinations.
Urgent care centers $$
Urgent care centers (such as Patient First or ExpressCare) have a doctor on staff and are another option when you need care on weekends or after hours.
Non-hospital facilities and surgery centers $$
X-rays, lab work and outpatient surgery will almost always cost more in a hospital setting. Pay less for these services by going to a participating non-hospital facility or surgery center. Prior authorization may be required for non-hospital outpatient services.
Outpatient hospital $$ vs. Inpatient hospital $$$
Outpatient services are received in the hospital without being admitted, such as same-day surgeries. Inpatient services are those received when you are admitted to the hospital. Prior authorization may be needed for hospital-based services.
Emergency room (ER) $$$
An emergency room provides treatment for acute illnesses and trauma. You should call 911 or go straight to the ER if you have a life-threatening injury, illness or emergency. Prior authorization is not needed for ER services.