How Your Coverage Works in an Emergency

When you have an illness or injury, you need to decide where to go for care. Many illnesses and injuries can be treated by your regular doctor, at a retail clinic or an urgent care center. But what if you're having signs of a heart attack? Broke your leg or blacked out after a nasty fall? When it's something serious, you need to go to the nearest hospital emergency room (ER).

ER doctors and staff treat serious and life-threatening health issues 24/7. When you get ER care, your copay and out-of-pocket costs will likely be higher than a trip to see your doctor. They’ll be even higher if you see an out-of-network provider.

Here are a few things you can do to help keep your out-of-pockets costs as low as possible when an emergency happens.

Be Prepared

Take some time now to educate yourself and prepare for a possible ER visit.

Find your nearest in-network hospital emergency room. Use our online tool to find an in-network ER near you. Log in to Blue Access for Members^SM, your online member account, and go to Find Care to locate network providers and hospitals.

Understand the basics about your health plan. Your benefit booklet includes a summary of your coverage and costs. You can also find information about your benefits in BAM. BAM offers 24/7 access to details about your plan’s benefits, claims information, member ID cards and more.

Keep your member ID card. Somewhere it’s always easy to find, like your wallet. Let someone you trust know where to find your card in case of an emergency. You can also share it with the BCBSMT App.

At the Hospital

• Keep a few things in mind during your ER visit. If you are told you need to be admitted, ask to be moved to a hospital that is in network. If you can’t ask up front, request to be transferred to a hospital in your plan’s network when you’re well enough.
• Call your doctor within 72 hours of being admitted to the hospital. If you can’t call, have a family member or member of the hospital staff call.

If you have an HMO plan, remember:

• Coverage for your emergency room visit ends once you’re admitted to the hospital and transitions to coverage for 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’s important to contact your doctor if you’re being admitted. Your doctor 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 others, may not be in your plan’s network. If possible, ask for team members who are in your plan’s network.

Involve Your Doctor

Your doctor is your health advocate. Involving them as soon as possible can help you get the care you need. If you are admitted to the hospital from the ER, make sure you or someone from your, family or the hospital calls your doctor within 72 hours. Even if you aren’t admitted, call your doctor after you leave the ER to schedule follow-up care.

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 limits and exclusions. If you want to verify your coverage, visit the My Coverage tab.

Originally published 1/14/2020; Revised 2024