Urgent Care is not Emergency Care. Urgent Care is needed when you have an injury or illness that must be treated within 48 hours. Your health or life are not usually in danger, but you cannot wait to see your PCP or it is after your PCP’s office has closed. If you need Urgent Care after office hours and you cannot reach your PCP, you can call our 24-hour Nurse Advice Line at 844-865-7920 or you can go to a participating Urgent Care center. You may also find the closest Urgent Care center to you by calling Member Services at 844-243-5131 If you would like to talk to your PCP’s office, the phone number is on the front of your ID card. Your PCP will have a doctor who monitors and returns calls also known as being “on call.” This doctor will call you back and tell you what to do. If you go to an Urgent Care center be sure to call your PCP the next day to ensure you get the follow up care you need.
If you need to go to the hospital for an appointment, surgery or overnight stay, your PCP will set it up. We must approve services in the hospital before you go, except for emergencies. We will not pay for hospital services unless we approve them ahead of time or it is an emergency. If you have a case manager, they will work with you and your provider to coordinate services when you go home from the hospital.
You have a medical emergency when you are so sick or hurt that your life or health is in danger if you do not get medical help right away. Some examples are:
These services try to keep you alive or to keep you from getting worse. They are usually delivered in an emergency room. If your condition is severe, call 911 or go to the closest emergency facility right away. You can go to any hospital or emergency facility. If you are not sure if it is an emergency, call your PCP. Your PCP will tell you what to do.
The hospital or facility does not need to be part of our provider network or in our service area. You also do not need to get approval ahead of time to get emergency care or for the services that you receive in an emergency room to treat your condition. If you have an emergency when you are away from home, get the medical care you need. Be sure to call Member Services when you are able and let us know.
Behavioral Health Services
There are times when you may need to speak to a therapist or counselor if you are having any of the following feelings or problems:
We cover many different types of behavioral health services that can help with issues you may be facing. You can call a behavioral health provider for an appointment. You can get help finding a behavioral health provider by:
Someone is there to help you 24 hours a day, 7 days a week.
You do not need a referral from your PCP for behavioral health services.
If you are thinking about hurting yourself or someone else, call 911. You can also go to the nearest emergency room or crisis stabilization center, even if it is out of our service area. Once you are in a safe place, call your PCP if you can. Follow up with your provider within 24-48 hours. If you get emergency care outside of the service area, we will make plans to transfer you to a hospital or provider that is in our plan’s network once you are stable.