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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
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?"
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