New Mexico Direct Caregivers Coalition
8 April 2017
Ask A Health Care Professional
By Eugene Sun, M. D., Vice It’ s sometimes difficult to President and Chief Medical decide where to go for my
Officer, Blue Cross and Blue health care. Does it make a
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difference where I go?
Yes. Where you go to get health care can make a big difference. You can get the same or very similar care in many different settings, but depending on where you go, there can be a huge difference in how much the care you receive costs and what your out-of-pocket costs are.
What are some examples of common situations and how I might handle them?
A very common situation is when you or someone in the family has a minor health care issue and you are not quite sure what to do. Perhaps you are taking care of a grandchild who has a fever of 100 degrees but no other symptoms. Maybe you twisted an ankle and have a little pain and swelling around the ankle but are otherwise able to walk and get around normally. In those types of situations, accessing a 24-hour nurse call line might be very helpful.
When you access a 24-hour nurse line, a registered nurse will ask you about the symptoms and anything else that may be going on. The nurses are trained to understand the difference between mild and moderate illnesses or injuries or when to suspect something more serious might be going on. They can
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give advice ranging from simple first aid and home care that you can safely do yourself, to when you should go to your doctor’ s office, an urgent care center, or even a hospital emergency department for very serious, possibly lifethreatening conditions.
What about annual health checkups or physical exams?
For preventive care services such as annual checkups, physical exams or sports physicals for children, the most cost-effective site is your primary care doctor’ s office. Plan to schedule your appointment well in advance of when you need the checkup or physical. Primary care doctors are often very busy and their schedule can be filled for weeks in advance. You can also get a checkup or physical exam in an urgent care clinic, and depending on your insurance coverage, it may not cost much more than going to your primary doctor. You should never get a routine checkup or physical exam at an emergency department. You will definitely pay more out of pocket for the same care.
What should I do if I have a bad cold or think I might have influenza?
For winter colds or flu symptoms, fever, chills, sore throat, or a runny nose, your primary care doctor or an urgent care clinic are your best choices. They can offer the basic diagnostic tests that might be needed and prescribe any necessary medications. Going to an emergency room with these symptoms is not a good choice. You will very likely wait a long time to be seen and will also likely end up paying much more, possibly up to five to ten times more, out of your pocket, for the same care you would receive in your doctor’ s office or an urgent care clinic. It is also
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not uncommon in an emergency room to receive additional tests or procedures that you don’ t really need.
What if I fall and injure myself?
For moderate injuries, such as a twisted ankle, where you are having severe pain and difficulty walking, an urgent care clinic may be just right for you. They usually have X-ray facilities on site and can determine whether you have a sprain or a fracture. They can apply splints, and sometimes casts, and refer you to the right specialist for follow-up.
What should I do if I think something really serious is happening to me?
For life-threatening emergencies, severe chest pain, difficulty breathing, serious injuries, or other critical conditions, a hospital emergency room is the best option. Depending on the situation, calling a nurse advice line or 911 will connect you with trained professionals that can help you figure out what to do and get help to you quickly.
It’ s important to understand the options available to you to get the right health care in the right setting, with the highest possible quality and the most affordable cost. Make sure you understand your coverage and health situation, and here’ s to your health!
If you have a health question or idea for an article that you would like to be considered in Ask a Health Care Professional, please e-mail AskHealthCareProfessional @ bcbsnm. com. BCBSNM will select questions that may appear. Questions will not be personally answered. The opinions expressed in this column are solely those of the author and not necessarily those of BCBSNM. This column is not intended to be a substitute for professional medical care.