Emergency Care -How Do I Get Care In An Emergency?

Healthy Way LA » Member Handbook » Emergency Care

(Source: HWLA Member Handbook 2011 – 2012)

There is a difference between needing care urgently and an emergency. Urgent care is when a condition, illness or injury is not life-threatening, but needs medical care right away.

How To Get Urgent Care
  • Call your medical home to see if they can see you; OR
  • Go to an urgent care clinic. These clinics are listed in the Provider Directory under “Urgent Care Centers”; OR
  • Call the Nurse Advice Line if you are not sure what to do.
What Is Emergency Care?
Emergency services for an emergency medical condition are covered in any hospital emergency department– 24 hours a day, seven (7) days a week. An emergency medical condition is a situation where a regular, sensible person would believe that not getting treatment right away will put his or her health at serious risk or could lead to serious harm to a bodily function, organ or part.

Emergency services and care include ambulance, medical screening, examination, and evaluation by a doctor or other medical personnel, as well as treatment and testing. Emergency services include both physical and psychiatric emergency conditions.

Examples of emergencies include but are not limited to:

  • Having trouble breathing
  • Seizures (convulsions)
  • Lots of bleeding
  • Unconsciousness/blackouts (when you can’t wake up)
  • Lots of pain (including chest pain)
  • Swallowing of poison or medicine overdose
  • Broken bones
  • Head injury
  • Eye injury

Examples of psychiatric emergency medical conditions include but are not limited to:

  • Serious thoughts or actions about hurting yourself or someone else
  • Unable to care for yourself, such as being unable to feed, shelter or dress yourself due to a mental disorder

If you think you have a health emergency, call 911.

You are not required to call your medical home doctor before you go to the emergency room.

Do not use the emergency room for routine (regular) health care or health care that could wait until you see your doctor or go to an urgent care center, otherwise you may have to pay for the cost of your care.

What To Do In An Emergency

Emergency care is covered at all times and in all places. Emergency services do not require a referral or okay from your medical home doctor.

Outside Of Los Angeles County?
If you are admitted to a hospital not in HWLA’s network because of a medical emergency, HWLA has the right to move you to a network hospital as soon as it is medically safe. If you do not want to move, you will have to pay for your care.

You may need hospital care after an emergency and after you are stabilized, so that you stay stabilized or so you get better. This is called post-stabilization care. If you do need this care, the hospital will call HWLA to ask for an okay to keep treating you there. The hospital may ask you for your name and phone number. Show the hospital your ID card. If you don’t have your ID card, tell them to call HWLA Member Services. If HWLA okays your post-stabilization care, you do not have to pay for it.

Your medical home doctor must provide or set up follow-up care when you leave the hospital.

What To Do After An Emergency
  1. Follow the instructions of the emergency room doctor.
  2. Call Member Services within 24 hours of receiving emergency care or as soon as you can.
  3. Call your medical home to make an appointment for follow-up care.
How To Get Emergency Transportation
Call 911 if you have an emergency. Ambulances for emergencies are paid for by HWLA as long as you had a reasonable belief that an emergency condition existed at the time of the service.
Not Sure You Have An Emergency?
If you are not sure, call your medical home or the Nurse Advice Line. Do what your medical home or theNurse Advice Line tells you to do. Non-emergency problems may include, but are not limited to, the following: earaches, colds, the flu and sore throats. Do not call 911 for non-emergency problems. Call your medical home or the Nurse Advice Line instead.
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