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What to do when you’re sick, ill or injured while in the USA
The U.S. health care system can be complicated and hard to navigate – especially for expats, visitors and even Americans who live away from home.
This article is designed to help you get the care and treatment you need while visiting the USA if you’re sick, injured or develop a condition. It covers types of injuries, elements of the health care system (Medicare, Medicaid, ER, and urgent care centers), what they’re for and how they work.
In the U.S., health care is delivered via urgent care centers, walk-in clinics and emergency rooms. The table below describes which you will need, depending on your ailment.
Click here for our comprehensive expat’s guide to the USA.
What to do when you’re ill in the USA
The graphic immediately shows you quickly and broadly which service to use based on how urgent and life-threatening the situation is. The table underneath it gives more detail on conditions and aspects of care, so, if you’re sick or injured and aren’t sure what to do, start from the left of the table and look for the condition that relates to you. This will tell you what level of care you need, the approximate costs and how you can access the care you need.
| Condition/Need | Level of Care | Approximate Cost | How to Access | Hours of operation/ wait times |
|---|---|---|---|---|
|
Severe Emergency | Dial 911 on your phone This will likely lead to having an ambulance sent to pick you up. |
24 hours | |
|
Inpatient Care (Overnight Stay) | Costs will vary by coverage and will usually include a deductible and some form of co-payment. | You may be admitted through the ER or your doctor may send you to be admitted after testing. | 24 hours |
|
Outpatient or ambulatory services | Costs will vary by coverage and will usually include a deductible and some form of co-payment. | These tests and services must be ordered by a doctor. Your family doctor, urgent care or walk-in clinic may order the tests and send you with a referral. | Open during business hours and can vary. |
|
Emergency care | Most expensive option Average cost of visit $377. |
Depending on the type of emergency, you may arrive in the ER by ambulance after a 911 call, or, in less severe circumstances, you may arrive by private auto. ALWAYS call 911 for chest pain. | ER is open 24 hours a day Average wait time for non-emergencies in the ER is 2.5 hours. |
|
Non-Emergency (Non-Life Threatening Conditions) | Average cost is $33 to $61. | Care can be received at an urgent care center or a walk-in clinic You can call ahead to see what the wait time will be or just turn up. No appointment is needed. |
Open during business hours and can vary. Average wait is 15 to 45 minutes. |
|
Preventive/Minor Care | Cost is generally lower Fees vary by physician and specialty |
Access preventive and basic well care at your family doctor’s office Appointment needed |
MD offices typically open from 8 or 9am to about 5 pm and hours can vary from office to office. |
|
Mental Health | Office visits will be lowest cost. Inpatient and ambulatory services will vary. | Physician office hours will vary. | |
|
Prescriptions | Price will vary based on the prescription | The prescription must be written by a medical provider in that state. See your local doctor, ER, urgent care or walk-in clinic to receive a prescription or they may phone it in or email it for you. | Hours vary but there are many 24 hour pharmacies in the U.S. |
U.S. health treatment cost comparisons
Non-emergency services for things such as
- Sprain
- Influenza
- Minor lacerations
- Headaches, migraine and tension
cost an average of $750 – $1,000 in an ER and $125 – $175 in an urgent care center.
Why choose a walk-in clinic or urgent care center?
It is tempting to head to the ER in many medical situations – especially if you are not aware of the other options available to you if you’re sick or injured while in the U.S.
Here are a few reasons to consider a walk-in clinic or urgent care center next time you need non-life threatening care:
- No appointment needed. Just walk right in.
- Convenient hours. Some are open seven days a week, with extended evening, weekend and holiday hours.
- Lower prices. You’ll almost always pay lower copays and out-of-pocket costs than you will at an ER.
- Less waiting. The average ER visit is significantly longer than a visit to a walk-in or urgent care facility.
- Many locations. It’s easy to find a walk-in or urgent care facility near you.
- Fully staffed. Urgent care centers are overseen by doctors with doctors providing the service, while walk-in clinics are overseen by doctors with nurse practitioners or physician assistants onsite.
- Connections with local ERs. If you need more extensive care, you’ll be referred to the closest ER.
I’m an Aetna member
If it’s not an emergency and you’re not sure what to do, call Aetna International using the toll-free number on the back of your Aetna International Member ID Card. Our customer service professionals will be able to answer your questions, look up providers and help you find the services you need.
The International Service Center is available 24 hours a day, call direct or collect (reverse the charges): +1-813-775-0190.
For more information on accessing the right care in the US, read/download our Aetna International Welcome Guide[NLJ1].
Health Hub
To find a doctor, access your plan documents, manage your claims, and access additional tools and resources, log in to the Health Hub — your secure member website.
Your secure member website gives you easy access to a world of useful tools. Use it to:
- View and manage claims
- Access policy information
- Find hospitals and healthcare providers
- Find travel safety and security information.
Letter of authorisation
If you become ill while overseas, your proposed treatment and associated costs might need to be authorised by Aetna International before it can be received. You will require a letter of authorisation (LOA, also know as preauthorisation), and it allows us to ensure you’re covered, protecting you from unexpected or unnecessary costs.
Help making a claim
Submitting a claim online is the fastest and easiest way for you to get reimbursed for money you have spent on health care services.
Finding out what’s covered by your plan
Not all treatments are covered on all policies. Before receiving any treatment, you should ensure it’s specified as a benefit in their policy documents. If you have any doubts about this, check your Certificate of Insurance, which is stored in the Health Hub, or call the Member Services team.
Glossary of U.S. health care terms
- Medicare is the government funded health insurance provided to U.S. citizens age 65 and over. There are deductible costs and co-payments with this plan.
- Medicaid is the government funded health insurance provided to U.S. citizens with lower income. They must qualify for this coverage.
- ER is the Emergency Room at a hospital where the most severe injuries are cared for and may lead to admission to the hospital for an overnight stay if needed. They have full access to all the diagnostic capabilities of the hospital and are staffed by physicians.
- Urgent care centers are standalone clinics that can treat many minor health problems and are typically staffed by physicians.
- Walk-in clinics are standalone as well and can treat minor aliments like colds, sore throat and flu. Many are open 7 days a week and are typically staffed by certified nurse practitioners and physician assistants.
Further reading
- Read about our one-nurse-one-patient support for a Saudi expat in the U.S.
- Can I record my doctor’s appointment?
- Tips for your next doctor’s visit
- 10 health checks you can do at home
- What does ‘best’ mean in health care?
- More about Aetna International’s CARE team
If you have any further questions on preauthorisation, accessing care or any other part of an Aetna International policy, you can contact our Member Services team 24/7, 365 days a year. Call the number on the back of your Member ID Card and we will be happy to help you.
This article will tell you what level of care you need, the approximate costs and how you can access the care you need.
