High Level Care for High Level Needs—2 Options for Immediate Assistance

High Level Care for High Level Needs—2 Options for Immediate Assistance

We've shared an overview of the choices you have for small but urgent matters, here are Paths 1, 2 and 3.   Now let’s talk about being ready, just in case something more serious comes your way.

So how do you know if you should go to an emergency room (ER)? Here’s a little ditty to help you decide: “If it could be the end of me, an ER is where I need to be.”

In other words, if it’s pretty clear that a medical condition is life threatening, then your only choice may be to go to the nearest emergency room. Some examples of emergency care include having chest pain or other signs of a heart attack or stroke, a deep wound that is bleeding a lot and heavily, a severe burn, or a serious head, neck or back injury.

All these and other serious conditions should always be treated at the ER. Call 911 for an ambulance or have someone take you to the nearest ER. Here are your options:

Hospital ER – If you know which nearby hospitals are in your health plan’s network, you can ask the ambulance to go there. If not, they will take you to the closest ER or one best equipped to take care of your emergency.

Freestanding ER - Not all ERs are located at hospitals. If the word EMERGENCY is part of a facility name, chances are you’re at an ER, even if it isn’t part of a hospital. Freestanding ERs are equipped like an ER and are staffed with ER doctors. They treat many life-threatening or disabling conditions.

Be aware that these ERs’ costs may be much higher than other options, just as if you went to the ER at a hospital. And unless the facility is part of a bigger hospital system, it may not be in your health plan’s network. Very few of them contract with insurers.

Here are some ways to know if you are at a freestanding ER. Freestanding ERs:

  • Look like urgent care centers but include EMERGENCY in facility names.
  • Are open 24 hours a day, seven days a week.
  • Are physically separate from any hospital.
  • Are subject to the same copay as a hospital ER and are staffed by ER physicians.
  • Can be more expensive than a hospital ER.

Remember: If it isn’t an emergency, call your doctor or go to an urgent care center instead.

Life and death situations don’t come often, but if you’re ever in the position to need an ER, you’ll know how to make the best choices for care. If you have questions on what your BCBSMT health plan covers, call the number on the back of your member ID card.

Originally published August 12, 2015; Revised 2019