Where to go in an emergency

If you’re faced with a medical emergency, you don’t need to call Horizon BCBSNJ Member Services before going to the ER.

If you find yourself in a true medical emergency:

  1. Go directly to the nearest Emergency Room (ER), or call 911 or your local emergency number.
  2. If you are able, call your doctor before you go to the ER. If you cannot call your doctor before you go, make sure to call within 48 hours or as soon as reasonably possible. If you are unable to call, have someone else call on your behalf.

It is important that your doctor is kept aware of your condition. Without this information, your doctor cannot properly coordinate your care or ensure that you receive the right care, at the right time, in the right setting.

What is a true medical emergency?
A true medical emergency is a medical condition of such severity that a prudent person with average knowledge of health and medicine would call for immediate medical attention.

Examples of true medical emergencies:

  • Uncontrolled bleeding
  • Poisoning
  • Obvious bone fractures
  • Signs of heart attacks and strokes
  • Difficulty breathing
  • Wounds requiring sutures
  • Loss of consciousness

Your Horizon BCBSNJ plan covers a medical emergency screening exam. This is an evaluation performed in an ER by a qualified health care professional to determine if a medical emergency exists.

If it is determined that a medical emergency does not exist, please follow up with your doctor for instructions. If you continue to receive services in the ER after you have been advised that your condition is not a medical emergency, you may be responsible for additional out-of-pocket costs.

Care on nights and weekends
Should you need to be treated after hours or on weekends for nonemergency care, your doctor or his or her covering health care professional is available 24 hours a day, seven days a week.

See your doctor for routine care
The best place for routine, nonemergency care is your doctor’s office. You and your doctor should:

  • Build a medical relationship
  • Develop a personalized treatment plan
  • Plan appropriate preventive measures
  • Discuss your family’s health history
  • Ensure that your treatment is appropriate

Additional resources

  • Urgent Care Centers: Participating urgent care centers throughout New Jersey treat patients who have an injury or illness that requires immediate care but is not serious enough for an ER visit. With extended and weekend hours, urgent care centers treat wounds, sprains and other conditions that are not life-threatening. All participating urgent care centers can perform essential services for diagnosis and treatment. For more information, read Urgent care centers: an alternative to the Emergency Room. To find participating urgent care centers visit Doctor and Hospital Finder.
  • 24/7 Nurse Line1: If you are unsure whether you require urgent or emergency care, call our 24/7 Nurse Line. Registered nurses who are specially trained in phone health care decision counseling offer prompt health information to help you make informed decisions about your health care. Our nurses can help you determine 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 appointments with your doctor more productive. This service is available 24 hours a day, seven days a week, at the number listed on the back of your Horizon BCBSNJ member ID card.

1Some members may not be eligible to use the 24/7 Nurse Line. Please check your plan to see if this service is available to you. If it is, this service can help you make decisions about nonemergency, health-related situations. It is for informational purposes only. Nurse Line nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor’s care. Nurse Line services are not an insurance program, emergency service or urgent care service, and may be discontinued at any time. In the event of an emergency, call 911 or your local emergency number and/or your doctor. Your Horizon BCBSNJ health plan covers you for medical emergency care 24 hours a day, seven days a week.

This article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.