What are emergency services?
Emergency services are services provided for an unexpected medical condition, including a psychiatric emergency medical condition, manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
- Placing your health in serious jeopardy
- Serious impairment to bodily functions
- Serious dysfunction of any bodily organ or part
In other words, emergencies are situations where immediate medical attention is required to prevent death or disability due to a sudden trauma or illness such as a stroke, severe pain, or an acute mental health episode.
When you need emergency care
If a person using reasonable judgment believes that an emergency situation exists, then prior authorization for services is not required.
If you believe that you have an emergency medical or mental health condition that requires immediate attention, you should seek care at the nearest medical facility. We encourage you to call 911 when appropriate.
For emergency room visits that do not result in direct admission to the hospital, you may pay an additional copayment as outlined in your Evidence of Coverage (EOC) or Certificate of Insurance (COI).