Getting Emergency Care
In an emergency, you should call 9-1-1 or go to the nearest emergency room (ER).
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It is an emergency if you reasonably believe that if you don’t get care right away, it could be dangerous to your life or to a part of your body. Emergencies include active labor, a bad injury, severe pain, and an illness that is suddenly getting much worse.
- If you can, go to the emergency room at a hospital in your health plan’s network.
- Try to take your membership card with you.
- If you are not sure if it is an emergency and there is time, call your doctor.
- If you are admitted to a hospital outside your plan’s network, call the plan within 24 hours, or as soon as you can. Your plan may move you to a hospital in its network, if it is possible without danger to your health.
Health plans only pay for an ambulance when:
- You call 9-1-1 because you think you are having an emergency and cannot get to the hospital safely or quickly enough in a car.
- Your doctor says you need an ambulance and the health plan pre-approves it.
Urgent care is care you need soon, usually within 24 hours, for a problem that is serious but is not an emergency. Examples include earache, a sprain, or a minor burn.
- If you need urgent care, call your primary care doctor or health plan. Health plans must provide telephone assistance 24-hours-a-day, 7 days a week, to help you get the care you need. The doctor or advice nurse should return your call within 30 minutes.
- Some plans have urgent care clinics you can go to directly.
- If you have a managed care plan, you should be able to get an appointment with your primary care doctor's office within 48 hours. If you need an urgent care appointment that requires pre-approval (such as an appointment with a specialist), you should be able to get an appointment within 96 hours.
Before you leave home, ask your plan how to get care when you are traveling.
- Emergency and urgent care are usually covered anywhere in the world.
- If you have an emergency, call 9-1-1 or go to the nearest ER.
- If you need urgent care, call your primary care doctor or the health plan if you can. If you cannot, go to the nearest clinic or urgent care center.
- Take your membership card with you.
- If you need follow-up care, call your primary care doctor.
- Try not to use the emergency room if you do not need to. Your health plan may not pay for your visit if it is not an emergency. Your co-pays can be high, and your wait can be long. And it is usually better to see your own doctor, who knows your health care needs.
- Your health plan must cover emergency care at any hospital. If your health plan will not pay for your emergency care, you can file a complaint with your health plan.
Call 9-1-1 for Emergency Services (Police, Fire, or Ambulance)
Call your doctor or your health plan's 24-hour advice line if you are not sure if it's an emergency
OPA materials: How to Use Your Health Plan Guide
OPA materials: California's HMO Guide for Seniors
OPA worksheet: My Emergency Contacts
How to file a complaint
Know your benefits
Referrals and pre-approvals