Emergency Care

How do I know if it is an emergency?

An emergency medical condition is a condition where the symptoms are of sufficient severity that a prudent lay person with an average knowledge of health and medicine would reasonably believe that the lack of immediate medical care could:

  • Place your health (or the health of your unborn child) at serious risk.
  • Impair the function of your body.
  • Impair the function of a body part or organ.

You do not need approval from us ahead of time for an emergency.  Any doctor or hospital can treat a sudden or serious medical problem.

What do I do in an emergency?

In an emergency, get help right away.  It does not matter if you are inside or outside of our service area.  You will be covered for emergency care even if the provider is not part of our network. 

  • Call 911, or go to the nearest emergency room for health care.  You do not need permission from us for emergency care.
  • Call 911 for an ambulance.  You do not need approval from us when it is an emergency.  However, non-emergency transportation may require approval from us or DHHR.

After you receive emergency services, you should call your PCP to plan your follow-up care.  You should do this if the emergency is at home or away.

Emergency Services

An emergency medical condition is a condition where the presenting symptoms are of sufficient severity that a prudent lay person with an average knowledge of health and medicine would reasonably believe that the lack of immediate medical care could:

  • Place the person’s health in jeopardy (concerning a pregnant woman, the health of the woman or her unborn child).
  • Harm the function of your body.
  • Harm an organ or body part.

Every situation is different.  If you or your family has an emergency, go to the nearest emergency room or 24-hour care center.  Dial 911 for ambulance service. 

There are times when it is hard to know what a real emergency is.  If you call your PCP before going to the emergency room, the doctor can tell you what to do. 

Here are some examples of times when you should use the emergency room:

  • Blackouts
  • Car accident
  • Chest pain or heart attack
  • Choking
  • Criminal attack (i.e. mugging or rape)
  • Danger of losing limb or life
  • Difficulty in breathing
  • Heavy bleeding
  • Loss of speech
  • Overdose of medicine or drugs
  • Paralysis (not able to move) 
  • Poisoning
  • Possible broken bones
  • Seizures
  • Vomiting (throwing up) blood

Here are some examples of when you probably do not need to go to the emergency room.

At these times, if you call your PCP, the doctor can tell you what you should do.

  • Bruises or swelling
  • Cold or cough
  • Cramps
  • Small cuts or burns
  • Earache
  • Rash
  • Sore throat
  • Vomiting (throwing up)