Your health plan covers more than just preventive care. It helps you in situations that you may not be able to prevent or avoid. Unexpected illness and accidents can happen to anyone and can be overwhelming. Having health care coverage can help you prepare for an unexpected health condition or accident.
First of all, emergency room visits cost more than a visit to your doctor, so you want to be absolutely positive that you need to go to the emergency room (ER). If you’re not sure, you can call your doctor for advice on how you should treat your health condition. If you can’t get in touch with your doctor, here is some information to help you decide if you need an ER or not. Health conditions like stomach aches, fevers or minor burns can be handled by making an appointment with your doctor.
If you believe your health issue is life-threatening, don’t wait. Call 911, or go to the nearest hospital emergency room. If you are admitted to the hospital from the ER, you or a family member should call your doctor within 72 hours. Involving your doctor as soon as possible can help you get the 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.
In Case of Emergency
- Know what your plan covers. Your benefit book includes a summary of your costs and coverage. You can find information about your benefits in Blue Access for MembersSM (BAMSM), your online member account. You have 24/7 access to details about your plan’s benefits, claims information and printable temporary ID cards.
- Know where to find your member ID card. Keep your member ID card in a place that is easy to find at all times, like your wallet. Let someone you trust know where to find your card in case of an emergency.
- Locate your nearest hospital emergency room or retail clinic. Use our Provider Finder® tool to locate your neighborhood in-network health care providers. To access Provider Finder, go to the Doctors and Hospitals tab in BAM.
Know What Your Plan Covers
- Be aware that the copay for visiting the emergency room is higher than the copay for visiting your doctor. Emergency room copays can cost you hundreds of dollars. To better understand your coverage benefits, you can check your plan details in BAM or call the number on your member ID card.
- If you’re admitted to a hospital that is not in your plan’s network, your stay may not be covered. This is why, when possible, it is best to contact your doctor prior to being admitted so you can be referred to a location that is in-network. If you do go to an out-of-network hospital, you may ask to be transferred to an in-network hospital for ongoing inpatient care once you are well enough.
Questions to Ask Before You’re Admitted to the Hospital
If you have an HMO plan, ask these questions to help you stay informed on cost and HMO coverage:
- Does this facility accept my health care plan?
- Does the facility provide the type of care you need, for example, cardiac care after a heart attack?
- What practitioner is on duty now — a doctor in your HMO network, a nurse?
- Is there a separate charge for any treatments I may receive?
If you have an HMO plan, it’s important to know that your HMO coverage for your emergency room visit ends once you’re admitted to the hospital.
If you are admitted to a hospital that is not in your HMO plan’s network, you will be charged the full cost of your treatment and stay. That’s why it is important to contact your PCP if you’re being admitted, so that your doctor can ensure you are referred to a facility that is in your network.