If you have an emergency, go to an Emergency Room (ER). If you need help getting to the ER fast, call 911. You do not need a referral from your PCP to use the ER. You should be seen within an hour to see the extent of your illness or injury. Call your PCP as soon as you can after getting emergency care.
After you get emergency care, the hospital must ask for approval within one hour for more care to keep you stable. If we do not respond in one hour or cannot be reached, or if we do not agree with the doctor on your care, we must let the doctor talk with our Medical Doctor. The doctor may continue the care until the Medical Doctor is reached or one of the guidelines is met. You may be treated in the ER, in a hospital room, or in another setting. This is called Post Stabilization Services.
What Is an Emergency?
Emergency means a condition with sudden symptoms so severe that lack of fast care could:
- Place the patient’s health in serious jeopardy;
- Seriously Impair bodily functions;
- Cause dysfunction of any body organ or part;
- Cause serious disfigurement; or
- In the case of a pregnant woman, jeopardize the health of a woman or her unborn child.
If you have an emergency, call 911 or go to the nearest ER.
Examples of Emergencies
- Severe pain
- Severe or unusual bleeding
- A serious accident
- A suspected heart attack or stroke
Examples of What Is NOT usually an Emergency
- Colds and flu
- Sore throats
- Bruises or minor cuts