Emergency Care is a medical condition showing itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or, with respect to pregnant women, the health of a woman or her unborn child) in serious jeopardy, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part.
Urgent Care is a situation where severe symptoms are present that do not qualify as a medical emergency but require care to prevent the problem from becoming a medical emergency.
Q. If I am in the health plan service area and need emergency care, what should I do?
A. If you need emergency care for a serious or life-threatening illness or injury, you should use 911 services when appropriate and/or seek care from the nearest physician or hospital. After treatment, contact your doctor within 48 hours or the next business day for follow-up care.
Q. What if my doctor's office is closed?
A. If you do not feel the situation is an emergency, call your physician’s office for information on how to contact the physician on-call, and follow their instructions for treatment. Then contact your doctor within 48 hours or on the next business day. If the situation is an emergency, see above instructions.
Your medical insurance plan covers emergency room care. However, the emergency room should be used only when care cannot be obtained at a participating physician's office during normal business hours.
Time permitting, call your primary care physician. However, if the illness or injury is life threatening go directly to the emergency room. If your primary care physician is not available, consider the following "medical emergency criteria"; your situation is a life threatening illness or injury requiring immediate medical attention, or the symptoms occur "suddenly" and "unexpectedly".