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 .