Emergencies and urgent care
A medical emergency is a medical problem so serious that you have to get care right away or you could be permanently disabled or die.
Wherever you are, get help immediately
All care needed to treat a medical emergency will be covered, whether or not you are in the Priority Health service area or the emergency room is in your provider network.
NOTE: If you go to an emergency room and it's not a medical emergency, your plan won't pay for the visit.
Call your PCP, if you have one
Call your primary care doctor or other primary health care provider's (PCP's) office as soon as possible, or have someone call for you if you are hospitalized.
- Your PCP needs to know about your emergency and should coordinate any follow-up and continuing care.
- Any follow-up care provided by an out-of-network provider will be covered at your out-of-network or "alternate" copayment/coinsurance.
- If you are hospitalized and your stay is no longer a medical emergency, Priority Health must approve your inpatient stay for the cost to be covered by your plan. Once you are stabilized Priority Health may require that you be transferred to an in-network facility.
Some examples of emergencies
- Injury to eyes or ears
- Trouble breathing after taking medication or being bitten by an insect
- A broken bone
- Chest or upper stomach pain
- Coughing up or throwing up blood
- Pain in the chest and one arm
- Bleeding that won't stop
- Poisoning or drug overdose
- Sudden dizziness or weakness
- Slurred speech
- Sudden difficulty seeing
An urgent medical problem is not life-threatening, but needs to be treated in the next 24 hours to keep it from getting worse.
In our service area
First call your primary care doctor or other primary health care provider ("PCP"), if you have one. A PCP knows their patients' medical histories and is in the best position to evaluate your needs. Your PCP MUST coordinate any follow-up and continuing care.
If your doctor isn't available but you can't wait:
You can set up a "virtual visit" This is a doctor visit online or by phone, available 24 hours a day, to take care of minor conditions like sinus infections, colds, strep, etc. A virtual visit will usually cost the same as a visit at your doctor's office. Learn more about virtual visits.
You can go to to an urgent care center in your plan's network. Use the online Find a Doctor directory to find an urgent care center that's in-network for you. Urgent care usually will cost a higher copayment than a regular doctor visit.
Call your PCP's office as soon as possible to coordinate follow-up care.
If you go to an urgent care center that is not in your plan's network
- Unless you are outside the Priority Health service area, you'll pay your higher "alternate benefit" copayment or coinsurance to go to an out-of-network urgent care center.
- Any follow-up care from the same out-of-network provider will also cost the higher out-of-network copayments/coinsurance.
Outside our service area
If you have to go to an urgent care center when traveling, you will pay your "preferred benefit" copayment or coinsurance.
Just be sure to let your PCP know about your visit, so he or she can coordinate any follow-up care you might need.