Emergency care

If you have a sudden and unplanned emergency and taking the time to call your primary care physician may mean permanent damage to your health, call 9-1-1 or go directly to the nearest hospital emergency room. A sudden and unplanned emergency refers to any condition that causes symptoms severe enough that someone with average health knowledge would believe that immediate medical attention is needed.

We cover emergency care for two types of problems:

• Accidental injuries are traumatic injuries which, if not immediately diagnosed and treated, could result in permanent damage to your health. The injury usually comes from outside sources and requires immediate medical attention such as broken bones, sprains, severe cuts, poisoning and burns. 
• Medical emergencies are conditions that appear suddenly and show signs and symptoms of sufficient severity, including severe pain, where the absence of immediate medical attention could reasonably result in serious jeopardy to your health. In the case of a pregnant woman, it would be reasonable to expect that the emergency could jeopardize the pregnancy. 

After the emergency has passed, your primary care physician can arrange appropriate follow-up care. Tell your doctor about your emergency within 24 hours or when it is medically reasonable to do so. If you cannot make the call, ask the hospital or someone acting for you to make the call.

Most hospitals bill us directly for emergency services provided to our members. If you happen to receive a bill, send it to us with an explanation of the service and your paid receipt. Use the Member Reimbursement form.

Related Items

• Should I go to the emergency room or urgent care?
• How to use your HMO benefits