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Getting the Right Care, in the Right Place, at the Right TIme

Navigating the health care system can be difficult even for those of us familiar with health care and insurance. If you suddenly find yourself with a medical need, where should go for health care?

By far the best way to navigate the health care system is to establish a relationship with a Primary Care Provider (PCP) who can help guide you to the right place if you need lab tests done or to see a specialist. PCPs are nurse practitioners or doctors that practice general, internal or family medicine, including pediatricians and certain ob/gyns. If you are looking for a PCP, please visit our online provider directory search and then make an appointment for an annual exam that we provide at no cost to you. It may take a while to get an appointment, but once you do so you can establish your relationship with your PCP and it will pay off if you ever become sick or injured.

Common Ground Healthcare Cooperative’s provider partnerships with Aurora Health Care and Bellin Health means that our members have access to a very low cost way to get immunizations, sports physicals, treatment for minor burns, rashes or insect bites and more. They can even do a rapid strep test, a pregnancy test and a urinalysis on site. Check out the web site links provided to see what you can get treated in these clinics which are located in very convenient locations. CGHC plans cover these services just as they would a doctor’s appointment.

A walk-in or urgent care center is another option for care, and is generally available at a lower cost than the emergency room. Hours and locations can be more convenient, although sometimes the waits can be long. Please be sure to go to an urgent care clinic that is in network! If you are traveling outside of our service area you can then visit an out-of-network urgent care, but if you are inside our coverage area you must visit an in-network facility. Also, you should be visiting urgent care centers for the right things: common illnesses or injuries that can’t wait for a doctor’s appointment. If you are looking for routine care such as immunizations or simple treatments for things like insect bites, you will probably save yourself time and money by going to a QuickCare or FastCare clinic.

In a serious or life threatening situation (i.e., chest pain, loss of consciousness, difficulty breathing, broken bones, uncontrolled bleeding) you should always go to the nearest emergency room. We understand that during an emergency, you will not always be able to go to an in-network emergency room. Because of this, Common Ground Healthcare Cooperative will cover out-of-network expenses for serious emergency care up to the maximum allowed amount. This will lessen any out-of-pocket expense to you if you happen to be at an out-of-network facility; however, you may be subject to “balance billing” from the facility. This means that if you go to an out-of-network emergency room, CGHC can only pay up to a certain amount, known as the “maximum allowed amount.” The facility does have the legal right to invoice the patient for the balance of that bill.

If you are not in a serious or emergency situation, then the emergency room is NOT a cost effective option. That’s because the cost of emergency room care is significantly higher than a doctor’s office, online, or walk-in care setting.