When you’re sick or injured, knowing where to go for care isn’t always easy — especially when you’re in discomfort and distracted. Knowing how to choose where to go for the right care can save you time, money, and stress.
At CalCPA Health, we believe education is one of the best tools you can use to take charge of your health. Here’s a guide to help you decide when to visit your primary care doctor, head to urgent care, or go to the emergency room, as well as what each might cost under most health plans.
Your Doctor (Primary Care Physician)
Best for: Routine care, chronic conditions, preventive visits, and minor issues during business hours.
Your doctor knows your medical history and can treat you more personally than in other care settings. For non-emergency symptoms like a mild rash, cough, cold, or stomach bug, this is often the best first stop if you can get an appointment. Primary Care Physicians are usually available during normal business hours and may also provide medical advice by phone after hours or even email you.
Typical cost with insurance:
Usually, it is a $$ copay, depending on your plan. *
Virtual Care (Telehealth)
Best for: Cold/flu symptoms, rashes, UTIs, minor infections, allergies, or when you need care quickly but it’s not an emergency.
Telehealth is available 24/7 with Anthem’s Sydney Health app (available to CalCPA Health members) or other virtual platforms. You can see a doctor at your convenience without leaving your home. It’s usually faster and lower cost than in-person visits.
Typical cost:
Often $ copay — check your plan summary for details. *
Retail Clinics (Walk-In)
Best for: Sore throats, earaches, pink eye, minor cuts or burns.
Located in places like CVS or Walgreens, these clinics are staffed by nurse practitioners or physician assistants and are great for quick, simple care when your doctor’s office is closed. This option is usually at a lower cost and wait time than urgent care but may have limited scope.
Typical cost:
Around $$ if self-pay, or your copay if using insurance.*
Urgent Care
Best for: Sprains, strains, minor broken bones, infections, moderate flu symptoms, or nausea that’s not life-threatening.
Urgent care is typically open daily, nights, and weekends, with access to lab tests, X-rays, and treatments not usually available at retail clinics. It’s a good choice when you need attention right away, but it’s not a 911-level emergency. Urgent care visits tend to be faster and more affordable than a visit to the ER.
Typical cost with insurance:
The copay is often $$$, depending on plan and services rendered. *
Emergency Room (ER)
Best for: Serious or life-threatening situations such as chest pain, breathing difficulties, heavy bleeding, signs of stroke, or major trauma.
Emergency Room visits should be reserved for true emergencies and will cost significantly more. They also often involve longer waiting times unless your condition is severe.
Typical cost with insurance: $$$$
ER visits can result in copays plus coinsurance (often a percentage of total charges), unless you’re admitted to the hospital for inpatient care, in which case the ER copay may be waived. *
Things to keep in mind
- Use virtual care because it is fast, affordable, and covered under most CalCPA Health plans as well as under other carriers.
- If it’s not urgent and it’s during business hours, check in with your doctor.
- Going to the ER for non-emergencies leads to higher costs and delays, care for those who have true emergencies.
- Understand your provider’s Summary of Benefits and Coverage to know your exact copays and coverage rules. (Summary of Benefits and Coverage for CalCPA Health medical subscribers)
- Be prepared and locate the nearest urgent care or 24/7 virtual care option now before you need it, and make sure that you share the information with your family so that they are ready for different medical situations that may arise.
- Keep your medical card handy, preferably via a mobile app. CalCPA Health medical members should download the Sydney App if they haven’t done so already.
- Use the “Find Care” tool to locate in-network providers.
CalCPA Health members have access to:
- The largest PPO provider network in California through Anthem Blue Cross
- 24/7 virtual care options
- One point of contact through our customer support team (Banyan Administrators) to help you with benefits, claims, or locating care
If you’re unsure where to go, call the customer support number on your ID card — they can guide you to the right care setting.
* If you are on an HSA-compatible HDHP, you might have to satisfy your Calendar Year Deductible before the Copay amount applies.
