Emergency Care

What Is an Emergency?

An "emergency" medical condition comes on suddenly or needs care right away.

Its symptoms are so severe, including severe pain, that without medical care right away you would expect:

  • The patient's health might be in serious danger.
  • The patient's body might be seriously harmed.
  • The patient's organs or parts might be seriously harmed.

What to Do in an Emergency

If you think you have an emergency, call 911 or your police department, or go to the nearest hospital emergency room.

You do not need a referral from your PCP for an emergency room visit. However, you or someone you know should tell your PCP about your emergency room visit by the next business day or as soon as your health allows. Tell your PCP what happened. Make a follow-up appointment with your PCP, if necessary.

If you get emergency care from a provider that is not in our network, you might have to pay for the difference between what is covered and what you were charged for the service. However, if you get emergency care outside the area where in-network providers are available, Community Health Plan will pay for your services.

Most follow-up services to make sure you are stable after emergency room care are covered based what on the emergency room physician tells us you need. Community Health Plan or your PCP must approve follow-up visits.

Community Health Plan covers emergency care in a provider’s office, clinic, urgent care center, or a hospital emergency room.

About urgent care centers: Emergency room visits do not require a referral or okay from your doctor or from Community Health Plan. However, if you go to an urgent care center, get a referral from your primary care provider before you go if you can. If you cannot get the referral from your PCP before you go, call your PCP the next day and get the referral then.