California Heath plans must cover emergency care,
even if you do not go to a hospital in your plan's
network. Any emergency room must treat you until you
are well enough to be moved to a hospital in your
health plan's network. Your plan must also cover
emergency care when you travel outside of your
plan's service area.
What Is an Emergency?
The
law says that it is an
emergency if
you reasonably believe that it is an emergency. It
is an emergency if waiting to get care could be
dangerous to your life or a part of your body. A bad
injury or a sudden serious illness can be an
emergency. Severe pain and active labor are also
emergencies. Your
California health plan
must cover emergency care no matter where you are
and what hospital you go to. However, you may be
moved to a hospital in your health plan's network
when you are stable enough to be moved.
What Is Urgent Care?
Urgent care is care you need within 24 to 48 hours.
Your health plan must cover
urgent care
when you travel outside your plan's service area. If
you are within your plan's service area, you must
use doctors in the network for urgent care.
Be
Prepared Ahead of Time
-
Ask
your primary care doctor what to do if you or
your child needs urgent care.
-
Ask
your primary care doctor or call your health
plan to find out where you can go for urgent
care or other after-hours care. You can also
find out about urgent care in your Evidence of
Coverage.
Tips
-
If
you can, call your doctor or an advice nurse
before you go to the hospital. Ask what you
should do.
-
Keep your Membership Card with you at all times.
-
If your plan will not pay
for the emergency or urgent care you received,
you can
file a complaint with your
plan.