My Coverage Explained
Your HMO coverage not only covers preventive care - it helps you in situations that may not be so avoidable. Unexpected accidents happen to everyone and can be overwhelming for the most put-together person. Let’s be real, there is never a good time to break an arm, fracture a rib or have chest pains. Having health insurance can help you prepare and breathe a little easier when an unexpected health condition or misfortune happens.
First of all, emergency room visits cost more than a visit to your Primary Care Physician (PCP), so you want to be absolutely positive you need to go to the emergency room. If you’re not sure, you can call your PCP for advice on how you should treat your health condition. They can help you decide if you need to come into the doctor’s office or go to the emergency room. Health conditions like stomach aches, fevers or minor burns can be handled by making an appointment with your Primary Care Physician.If you believe your health issue is life-threatening, don’t wait! Call 911, or go to the nearest hospital emergency room. The emergency room will then reach out to us to approve your care. If you are admitted to the hospital from the ER, you or a family member should call your PCP within 72 hours. Involving your PCP as soon as possible can help you get the care you need. Even if you aren’t admitted, you will still need to call your doctor soon after you leave the hospital to schedule follow-up care.What to remember in case of emergency:Be prepared
Know what your HMO plan covers
Questions to ask before you’re admitted to the hospitalIt’s important to know that your HMO coverage for your emergency room visit ends if you’re admitted to the hospital. This means that if you are admitted to a hospital that is not in your network of providers, you will be charged the full cost of your treatment and stay. That’s why it is important to contact your PCP if you’re being admitted, so that they can ensure you are referred to a facility that is in your network.
Ask these questions to help you stay informed on cost and HMO coverage:
There’s a lot to consider when deciding where you should go for care. We’re here to help you understand all of your options.Not all benefits are offered by all health plans. Please refer to your benefit materials or log in or register for your member account, Blue Access for Members to see the limitations and exclusions in your plan. If you want to verify your coverage and identify your medical group and PCP, all you have to do is to visit the My Coverage tab.
Questions? Register for Connect and ask us in the comments!
Disclaimer: The information provided in this document is based on current information, should not be considered comprehensive and should not be relied upon for benefit decisions. It should not be considered legal or tax advice.
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Blue FocusCare Bronze 209 says out of network hospital stay benefit NOT covered. What happens if I have emergency accident, serious enough it requires some immediate surgery, and I must recover for a few days, weeks, etc. in the hospital - again - as a RESULT of the emergency. I was taken by ambulance to an OUT OF NETWORK hospital (I had no choice in the accident location and available hospital) - so does that mean my hospital stay in that out of network hospital is NOT AT ALL covered? I have to pay the full bill for every day of the hospital stay because the emergency occurred "out of network?"
Hello, If you could send us a private message, I can have someone look into your emergency room visit for you. ~ Heather
How do is end you a private message? And I’m asking this theoretically. I’m looking at purchasing this plan, but your documentation is not clear on if ANY kind of hospital stay OUT OF NETWORK would be covered. In fact, the summary sheet says benefit not covered and this webpage here I’m commenting on says not covered - but will transfer you to in network when you’re stabilized. So I’d have to pay the out of network hospital stay (the days after I was admitted after the emergency care) fully out of my own pocket until they transfer me to in network hospital?
You can send a private message by clicking on the link in the upper right hand corner. However, if you don't currently have a plan with us, you would need to speak with our sales department about the specifics of the plans available to you. You can reach them at 855-599-1515. ~ Heather
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