What are Urgent Services?
Urgent services are defined as those covered services (other than emergency services) which are medically necessary to prevent serious deterioration of your health, alleviate serious pain, or treat an unforeseen illness, injury or medical condition with respect to which treatment can not reasonably be delayed until the you return to your plan's service area.
For example, urgent care is needed when a condition requires prompt medical attention - usually within 24 hours - to avoid complications and unnecessary suffering, such as high fever or persistent diarrhea, and to keep the condition from becoming a serious health problem.
Urgent Care near home or work
Please contact your physician's office to determine whether urgent care is needed for your situation and to locate an urgent care center near your work or home.
When we say "near work or home," we mean within your primary care physician's service area (i.e., the geographic area served by your physician's medical group or IPA).
You can phone your doctor's office or IPA/medical group to find out more about your physician's service area. Primary care physicians have telephone access 24 hours a day, seven days a week.
Urgent Care in another part of the state
When you need urgent care and you are outside of your primary care physician's service area, you must still contact your primary care physician. He or she is responsible for arranging your urgent care and has telephone access 24 hours a day, seven days a week.
Urgent Care outside of California and beyond the United States
Your plan covers urgent care outside of California and around the world. In an emergency, you should always seek care at the nearest medical facility. However, seeking care from a provider within the Blue Shield Global Core network can expedite the receipt of care and plan benefits.
You can locate a BlueCard provider at any time with Find a Doctor or by calling (800) 810-BLUE (2583). You should also travel with your Blue Shield ID card because it contains information that a BlueCard provider will need.
There are still some remote areas where BlueCard providers are not available. In an instance when you receive urgent care from a provider who is not in our network, you may need to submit a claim to Blue Shield of California within one year.
For information on how to submit a claim, refer to your Evidence of Coverage (EOC) or Certificate of Insurance (COI). We will make a coverage decision within 30 to 45 days of receiving your complete claim.