Urgent Care & Emergency Room
Whether it’s a sprained ankle, a bad fever, or something more serious, knowing where to go and what’s covered once you’re there can save you time, money, and a lot of stress. Here’s how to choose the right care and use your benefits along the way.
Review the 2027 Benefits eGuide for complete plan details.
At a Glance
Not every situation calls for the emergency room. Knowing your options ahead of time helps you get the right care fast — without an unnecessary bill.
Choose Your Care
Here’s how your options compare, so you can pick the right one for your situation:
Teladoc Health — Fastest and lowest-cost option: $10 per visit if you’re enrolled in a BCBSTX medical plan, available 24/7 by phone or video. Good for allergies, cold/flu, ear infections, pink eye, stress, or depression.
Your Primary Care Physician (PCP) — Moderate speed, low cost — in-network preventive visits are free. Best for annual physicals, flu shots, well-child visits, immunizations, and everyday health concerns, plus referrals to specialists when you need them.
Urgent Care — Fast, moderate cost, walk-ins welcome. A good option when you need help quickly, but it isn’t life-threatening. Think a sprained ankle, a bad ear infection, a high fever, back pain, migraines, minor fractures, or a cut that needs stitches — especially when your PCP isn’t available.
Emergency Room — Immediate for true emergencies, but long waits for non-emergencies, and the highest cost. Go to the nearest ER or call 911 for chest pain, trouble breathing, severe injuries, or broken bones.
At Your Visit
A few things to know while you’re being seen:
Your plan pays differently depending on how you’re enrolled. If you’re in the HSA Basic or HSA Plus medical plan, you’ll pay the full cost of care until you meet your deductible. Then, if you're enrolled in the HSA Basic medical plan, you won't pay anything else. If you're enrolled in the HSA Plus medical plan, the plan starts sharing costs. If you’re in the PPO plan, you pay set copays for visits and start sharing costs after you meet your deductible.
Getting a prescription? Your BCBSTX medical plan's prescription drug coverage, administered by Optum Rx, applies whether the prescription comes from Teladoc, your PCP, urgent care, or the Emergency Room.
Need help understanding your bill or finding an in-network option nearby? A personal concierge through Benefits Value Advisors, available through all BCBSTX medical plans, can help you find in-network care, estimate costs before you go, or make sense of a bill afterward.
After an Injury
If you were treated for an accidental injury — a broken bone, a concussion, a laceration — Accident Insurance (if you’re enrolled) can help offset the costs.
File a claim for cash paid directly to you. Accident Insurance through Voya pays a cash benefit for covered injuries, which you can use for anything — copays, deductibles, or everyday expenses. Contact Voya to report a claim.
If it’s More Serious
Sometimes an urgent care or ER visit turns into something bigger. A couple of benefits are there if that happens.
Admitted to the hospital? Hospital Indemnity (Voya), if you’re enrolled, pays you directly — $1,000 for the admission, plus $200 per day for up to 30 days of a covered stay.
Diagnosed with a major illness? If your visit leads to a diagnosis like a heart attack, a stroke, end-stage renal failure, major organ failure, or invasive cancer, Critical Illness insurance (if enrolled) pays a lump sum of $15,000 or $30,000 directly to you.
Contact Voya to file a claim.
Next Time
A few things worth keeping in mind before you need care again:
When in doubt, start with Teladoc or your PCP. They’re your fastest, lowest-cost options for anything that isn’t an emergency.
Save the ER for true emergencies — chest pain, trouble breathing, severe injuries, or broken bones — to avoid more expensive and time-consuming care.
If you’re enrolled in Accident Insurance, Critical Illness, or Hospital Indemnity coverage, you and each covered dependent can also earn a $75 health screening benefit for completing routine screenings like an annual physical, colonoscopy, or mammogram — up to $225 per covered person per year across all three plans.
Keep this handy through every step
Try Teladoc or your PCP first for anything that isn’t an emergency
Know your plan type (HSA Basic, HSA Plus, or PPO) before you go
File an Accident Insurance claim if you were treated for a covered injury
File a Hospital Indemnity or Critical Illness claim if your visit led to a hospital stay or major diagnosis
Receive cash for a health screening if you’re enrolled in Accident Insurance, Critical Illness, or Hospital Indemnity
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