Heath plans must cover emergency care, even if you do not go to a hospital in your plan's network. Any emergency room must treat you until you are well enough to be moved to a hospital in your health plan's network. Your plan must also cover emergency care when you travel outside of your plan's service area.
What Is an Emergency?
The law says that it is an emergency if you reasonably believe that it is an emergency. It is an emergency if waiting to get care could be dangerous to your life or a part of your body. A bad injury or a sudden serious illness can be an emergency. Severe pain and active labor are also emergencies. Your health plan must cover emergency care no matter where you are and what hospital you go to. However, you may be moved to a hospital in your health plan's network when you are stable enough to be moved.
What Is Urgent Care?
Urgent care is care you need within 24 to 48 hours. Your health plan must cover urgent care when you travel outside your plan's service area. If you are within your plan's service area, you must use doctors in the network for urgent care.
Be Prepared Ahead of Time
- Ask your primary care doctor what to do if you or your child needs urgent care.
- Ask your primary care doctor or call your health plan to find out where you can go for urgent care or other after-hours care. You can also find out about urgent care in your Evidence of Coverage.
If your plan will not pay for the emergency or urgent care you received, you can file a complaint with your plan.
- You may not be balanced billed for emergency services. You are only responsible for any applicable deductible or co-payments.
- If you can, call your doctor or an advice nurse before you go to the hospital. Ask what you should do.
- Keep your Membership Card with you at all times.