Should I Stay or
Should I Go?
Are
your symptoms E.R. worthy? Or are you about
to pay a higher copayment or be denied coverage and need to pay for
non-emergency services entirely out-of-pocket-for an emergency room visit that could’ve
been more effectively, and more economically, served elsewhere? According to the Centers of Disease Control
and Prevention, 10 percent of the nation’s more than 110 million emergency room
visits in 2002 were classified as “nonurgent.”
That means over 11 million people overpaid for their care.
If
you reasonably believe that you have an emergency, you should go to the nearest
medical facility or call 911, when appropriate.
An emergency is defined in your Evidence of Coverage as “an unexpected
medical condition, including a psychiatric condition, that manifests as acute
symptoms of sufficient severity, including severe pain, so that the absence of
immediate medical attention could reasonably be expected to result in placing
the person’s health in serious jeopardy, serious impairment of bodily
functions, or serious dysfunction of any body organ or part.”
If
you’re an HMO member and you don’t believe you have an emergency, as defined
above, contact your Personal Physician who must provide or authorize you all
urgent care services. Your Personal
Physician has telephone access available 24 hours a day, seven days a week. If you do access the Emergency room of a
hospital, you must contact your Personal Physician within 48 hours in order to
have the emergency visit authorized. Any
follow-up care should be coordinated by your Personal Physician.
If
you’re a PPO member and you don’t believe you have an emergency, as defined
above, you should consider:
For more information you can contact
Blue Shield of California or visit them at