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Knowing you have health care coverage that you can count when an accident or unexpected health crisis strikes means you can breathe a little easier. After all, there’s never a good time to break an arm, fracture a rib or have chest pains.
A visit to the emergency room costs more than a visit to your primary care physician (PCP). That’s why it’s important to be absolutely positive you need to go to the emergency room. If you’re not sure, you call your doctor for advice. Together, you can decide if you need to go to the doctor’s office or the emergency room. For stomach aches, fevers, minor burns and other health issues, make an appointment to see your PCP.
If you believe your health issue is life-threatening, don’t wait. Call 911, or go to the nearest hospital emergency room right away. The emergency room will then reach out to us to approve your care. If you’re 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 post-ER 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.
While emergencies happen suddenly, a little advance planning can help you when minutes count.
It’s important to know that your HMO coverage for your emergency room visit ends if you’re admitted to the hospital. Remember, if you’re admitted to a hospital that is not in your network of providers, you’ll be charged the full cost of your treatment and stay. It’s important to contact your PCP if you’re being admitted so they can ensure you are referred to a facility that is in your network.
Ask these questions:
There’s a lot to consider when deciding where to 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 to 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, visit the Coverage tab.
Questions? Register for Connect and ask us in the comments.
Originally published 4/28/2015; Revised 2023
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
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?
Hello, If you could send us a private message, I can have someone look into your emergency room visit for you. ~ Heather
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