Getting Emergency Care
A true medical emergency is a medical condition of such severity that a prudent person with average knowledge of health and medicine would seek immediate medical attention. Examples include:
- Uncontrolled bleeding
- Obvious bone fracture
- Signs of a heart attack or a stroke
- Difficulty breathing
- Wounds requiring stitches
- Loss of consciousness
If you have a medical emergency:
- Go directly to the nearest Emergency Room (ER) or call 911.
- If you can, call your doctor before you go. If you can’t, be sure to call within 48 hours or as soon as possible. Someone else can call on your behalf. It’s important that your doctor is aware of your condition so he or she can coordinate follow-up care.
You don’t have to call us before you go to the ER. Your health plan covers you for medical emergency care, 24/7. Your health plan also covers you for a medical emergency screening exam. The exam is done in an ER by a qualified health care professional to determine if a medical emergency exists.
If the health care professional determines that a medical emergency does not exist, please follow up with your doctor for care. If you continue to get care in the ER, after you’ve been told that your condition is not a medical emergency, you may be responsible for the cost of your care.
If it’s not an emergency, you have options for your care:
See your doctor.
The best place for routine, nonemergency care is your doctor’s office. You and your doctor should:
- Build a medical relationship.
- Discuss your family’s health history.
- Plan appropriate preventive measures.
- Develop a treatment plan that’s right for you.
Go to an in-network urgent care center.
Urgent care centers can help you with illnesses and injuries that need immediate care but aren’t serious enough for an ER visit. All in-network urgent care centers can perform basic diagnosis and treatment services.
Use your telemedicine benefits.
Sign in or call 1-877-716-5657 to access your confidential telemedicine service that gives you 24/7 access to care.
Use the 24/7 Nurse Line.
Registered nurses who are specially trained in phone health care decision counseling can give you information you can use to make decisions about your health care. Our nurses can help you decide if you need to go to an ER, an urgent care center or your doctor’s office, or if self-care is right for your needs. They can also coach you on how to make your appointments with your doctor more productive. To talk with a nurse, call the number listed on the back of your member ID card.