Health Benefits

Telehealth, Urgent Care, or Emergency Room?

Image of an Asian grandmother with her granddaughter video calling doctor from home with a laptop. Telemedicine and new normal during covid-19 pandemic.

Your CalPERS health plan provides you choices on receiving care for prevention, accidents, and illness. Typically, your options are to use a telehealth service, visit your doctor’s office, head to an urgent care center, or go to the emergency room (ER).

Here are some general guidelines to help you make an informed decision on where to get the care you need — when you need it. Never hesitate to call 911 or make a trip to the ER if you start to experience serious or life-threatening symptoms such as sudden chest pain, difficulty breathing, loss of consciousness, excessive bleeding, broken bones, or high fever.

Telehealth Is Ideal for Non-Urgent Issues

A telehealth clinician can diagnose and treat many non-urgent medical issues, follow up on a chronic health problem, and even submit a prescription for pickup. Telehealth is a good option for routine check-ins and non-urgent medical issues that don’t require a physical examination. You can consult with a clinician by phone or a face-to-face video conference for conditions including:

  • Cold and flu symptoms
  • Respiratory infection
  • Ear infection
  • Urinary tract infection
  • Non-life-threatening allergies
  • Skin conditions like acne or eczema
  • Non-urgent behavioral health services

Visit Your Doctor’s Office for Routine Care and More

You can make an appointment to see your primary care provider (PCP) for preventive care, routine check-ups, management of chronic conditions such as diabetes, ongoing health concerns or any of the conditions as a telehealth appointment listed above.

Establishing and maintaining a relationship with your primary care provider for preventive care, management of chronic conditions, and comprehensive coordination of all your health care needs can help improve health outcomes.

Seek Urgent Care for Time-Sensitive Illness and Non-Life-Threatening Injuries

Urgent care centers are for non-life-threatening injuries and illnesses that are more time-sensitive or require more prompt attention than a routine in-person or telehealth visit. You can follow up with your primary care doctor afterwards.

Many urgent care centers have extended hours. For health maintenance organization (HMO) plan members, you will want to make sure to use urgent care clinics that are in-network, otherwise you may be responsible for the cost of service.

Urgent care can provide diagnostic services such as blood tests and X-rays to treat conditions such as:

  • Small cuts requiring stitches
  • Sprains and strains
  • Flu, cough, and congestion
  • Sore throat
  • Vomiting, diarrhea, and dehydration
  • Painful urination
  • Eye and ear infections
  • Rashes
  • Bites

Go to the ER for Immediate, Life-Threatening Medical Care

When you need immediate, life-threatening medical care, get to the nearest emergency room or call 911. ERs offer around-the-clock care but often have unpredictable wait times. Go to the ER for:

  • Chest pain
  • Difficulty breathing
  • Weakness or numbness on one side
  • Slurred speech
  • Fainting or changes in mental state including concussion, confusion, and seizure
  • Broken bones and dislocated joints
  • Serious burns and shock
  • Heavy bleeding
  • Head or eye injuries, or cuts on the face
  • Fever over 103 degrees or fever with a rash
  • Severe cold or flu symptoms
  • Serious back or neck injuries
  • Drug overdose
  • Poisoning

Be Ready to Make Informed Decisions

Be ready by having a plan for urgent or emergency situations. It helps to know your options by working with your primary care clinician or health plan to identify in-network urgent care clinics and emergency rooms for immediate or after-hours care. CalPERS HMOs also provide a 24/7 nurse advice line which can help you decide which option might be best for you.