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.
Where to get Urgent Services
To minimize your health care costs, you should consider seeking urgent care from a preferred urgent care facility. You could end up paying more when you use a non-preferred provider.
To locate the closest preferred urgent care facility:
- Use Find a Doctor
- Check your printed copy of our "Preferred Physician, Hospital, Urgent Care and Ambulatory Surgery Center Directory"
- Contact us
These preferred facilities are located at private offices - not hospital emergency rooms - that offer extended office hours, including weekends. They will not require that you make an appointment in advance.
Urgent care outside of California and beyond the United States
The BlueCard program helps you access urgent services across the country and around the world when you are traveling outside of California. However, you are not required to seek care from a provider in the Blue Shield Global Core network for urgent services.
You can locate a BlueCard provider at any time using Find a Doctor or by calling (800) 810-BLUE (2583). You should always travel with your Blue Shield ID card because it contains information that a BlueCard provider will need.
When receiving care from a BlueCard provider outside of California, you may be asked to pay your copay or deductible at the time of your visit, based on health plan. Once you've received services from a BlueCard provider, you will be sent an Explanation of Benefits (EOB) showing what you owe.
If you access care from a provider who is not in the BlueCard network, your coverage is at the non-preferred level and may include a higher copayment and responsibility for any charges over Blue Shield's allowable amount. Get specific details in your Evidence of Coverage (EOC) or Certificate of Insurance (COI).
In an emergency, you should always seek care at the nearest medical facility.
Whenever you receive care outside of California, you should notify your physician when you return, so he or she can provide any necessary follow-up care.