How Your Coverage Works in an Emergency

How Your Coverage Works in an Emergency

When you have an illness or injury, you’ll need to decide where to go for care. Many illnesses and injuries can be handled by your regular doctor or at a retail clinic or an urgent care center. If they’re serious enough, though, you may need to go to the nearest hospital emergency room (ER).

When you do go to the ER, your out-of-pocket cost share will be higher than what you pay to see your doctor. Here are a few things to keep in mind to keep your costs as low as possible when an emergency happens.

Call Your Doctor

If you are admitted to the hospital from the ER, you, a family member or hospital staff should call your doctor within 72 hours. Involving your doctor as soon as possible can help you get the care you need. Even if you aren’t admitted, call your doctor after you leave the hospital to schedule follow-up care.

Be Prepared

It’s a good idea to have a few things in an easy-to-find spot in case you go to the ER.

Locate your nearest in-network hospital emergency room and retail clinic. Use our Provider Finder® tool to locate your neighborhood in-network health care providers. To access Provider Finder, log in to Blue Access for MembersSM, your online member account, and click on the Find a Doctor or Hospital tab.

Know where to find your member ID card. Keep your member ID card in a place that is easy to find at all times, like your wallet. Let someone you trust know where to find your card in case of an emergency. Or you can share it with them from the BCBSMT App.

Know the basics about what your plan covers. Your benefit booklet includes a summary of your costs and coverage. You can find information about your benefits in BAM. You have 24/7 access to details about your plan’s benefits, claims information and printable temporary ID cards.

Keep in mind that:

  • ER copays can be a lot higher than doctor visit copays.
  • If you are told you need to be admitted, ask to be moved to a hospital that is in network. If you aren’t able to ask when admitted, ask when you’re well enough if you can be transferred to a hospital in your plan’s network.

If you have an HMO plan, it’s important to know that:

  • Coverage for your emergency room visit ends once you’re admitted to the hospital (in other words, your care transitions to a hospital visit).
  • If you are admitted to a hospital that is not in your HMO plan’s network, you will be charged the full cost of your treatment and stay. That’s why it is important to contact your doctor if you’re being admitted, so they can make sure you’re referred to a facility that is in your network.
  • Some providers who work at in-network hospitals, such as anesthesiologists, imaging technicians, and so forth, may not be in your plan’s network. If circumstances permit, ask for team members who are in your plan’s network.
We Can Help You Understand Your Options

Not all benefits are offered by all health plans. Please refer to your benefit materials or log in to BAM to see your plan’s limitations and exclusions. If you want to verify your coverage, visit the My Coverage tab.

If your symptoms are life threatening (for example chest pain, trouble breathing, heavy bleeding), call 911 or go to the nearest hospital emergency room.