When you or a member of your family needs medical attention, knowing the right place to go for care is critical to getting the care you need and getting the most from your benefits. Review these tips so you will know where to go to get the care you need ahead of time.
Get the Right Care at the Right Place
When you need medical care, know where to go or what to do. Your choices include:
- Making an appointment with your primary care provider (PCP)
- Going to an urgent care center
- Going to the emergency room (ER)
- Using our Telehealth Services from Teladoc
If Your Health Issue Isn’t Life Threatening, See Your PCP
Visit your PCP if you need:
- Help with things like colds, flu and fevers
- Treatment for an ongoing health issue like asthma or diabetes
- A general checkup
- Vaccinations
- Advice about your overall health
- Preventive care or screenings
When to Go to an Urgent Care Center
An urgent care center gives fast, hands-on care for sickness or injuries. These are things that aren’t life threatening but need to be treated within 24 hours. An urgent care center is a good choice if you can't see your PCP right away.
Common urgent care issues include:
- Sprains
- Ear infections
- High fevers
- Flu symptoms with vomiting
First call your PCP. He or she may give you care or advice over the phone or direct you to the right place. If your PCP’s office is closed, do one of these things:
- At QualChoice.com, choose Find a Doctor or Hospital. Type in your zip code and under Other Facilities, choose Urgent Care Center.
- At QualChoice.com, choose Telehealth Services in the Member section under Using Your Benefits. Follow the links to set up a Teladoc account to get help 24 hours a day.
Check your coverage certificate for your urgent care cost share. After your visit, let your PCP know you were seen at an urgent care and why.
When to Go to the Emergency Room (ER)
Anything that endangers your life (or your unborn child’s) without medical help right away is an emergency. Emergency services treat injuries or the onset of what appears to be a medical problem. We cover emergency medical and mental health care both in and out of our service area.
Note: Providers that treat you in the ER may not be in the QualChoice network. In that case, they may balance bill you for the difference between our allowed amount and their billed charge. Be sure to ask your providers if they are in-network so you don’t end up with surprise charges.
Check your coverage certificate for more about provider billing and balance billing.
Go to the ER if you have:
- Broken bones
- Bleeding that won’t stop
- Labor pains or other bleeding (if you’re pregnant)
- Severe chest pains or heart attack symptoms
- A drug overdose
- Poison danger
- Bad burns
- Shock symptoms (sweat, thirst, dizziness, pale skin)
- Convulsions or seizures
- Trouble breathing
- The sudden loss of sight, movement or speech
- Gun or knife wounds
Don’t go to the ER for:
- Flus, colds, sore throats or earaches
- Sprains or strains
- Cuts or scrapes that don’t need stitches
- Prescription refills
- Diaper rash
What if you need emergency care out of our service area?
Your plan will pay for emergency care out of the county or state. If you go to an out-of-network ER and you don't have a true emergency, you may have to pay any amount above what your plan covers. Those added amounts could be very high. You would also have to pay your plan’s cost sharing amount and deductible.
Use our 24/7 Telehealth Services if you need:
- To know whether you should seek medical treatment right away
- Help caring for a sick child if you can’t see your PCP
- Answers to questions about your health
