Emergencies and urgent care
If you have questions about the emergency or urgent care coverage information on this page, contact Customer Service.
A medical emergency is a medical problem so serious that you have to get care right away or you could be permanently disabled or die.
Wherever you are, get help immediately
All care needed to treat a medical emergency will be covered, whether or not you are in the Priority Health service area or the emergency room is in your provider network. BUT:
- If you go to an emergency room and it's not a medical emergency, your plan won't pay for the visit.
- When you get emergency care services from a provider who's not in your plan's network, your plan will only pay the "reasonable and customary" cost of those services. The provider might bill you for the difference.
Then call your PCP
Call your primary care doctor or other primary health care provider's (PCP's) office as soon as possible, or have someone call for you if you are hospitalized.
- Your PCP MUST coordinate any follow-up and continuing care.
- Any follow-up care provided by an out-of-network provider must be pre-approved by Priority Health to be covered.
- If you are hospitalized and your stay is no longer a medical emergency, Priority Health must approve your inpatient stay for the cost to be covered by your plan. Once you are stabilized Priority Health may require that you be transferred to an in-network facility.
Some examples of emergencies
- Injury to eyes or ears
- Trouble breathing after taking medication or being bitten by an insect
- A broken bone
- Chest or upper stomach pain
- Coughing up or throwing up blood
- Pain in the chest and one arm
- Bleeding that won't stop
- Poisoning or drug overdose
- Sudden dizziness or weakness
- Slurred speech
- Sudden difficulty seeing
In our service area
An urgent medical problem is not life-threatening, but needs to be treated in the next 24 hours to keep it from getting worse.
First call your primary care doctor or other primary health care provider (a "PCP"), if you have one. A PCP knows their patients' medical history and is in the best position to evaluate your needs. Your PCP MUST coordinate any follow-up and continuing care.
If your doctor isn't available but you can't wait:
You can set up a "virtual visit" This is a doctor visit online or by phone, available 24 hours a day, to take care of minor conditions like sinus infections, colds, strep, etc. A virtual visit will usually cost the same as a visit at your doctor's office.
You can go to to an urgent care center in your plan's network. Use the online Find a Doctor directory to find an urgent care center that's in-network for you. Urgent care usually will cost a higher copayment than a regular doctor visit. Call your PCP's office as soon as possible to coordinate follow-up care.
Go to the Find a Doctor directory now.
If you go to an urgent care center that is not in your plan's network
- You will pay 100% of the cost of your care.
- Any follow-up care from the same out-of-network provider must be pre-approved by Priority Health.
Outside our service area
Call your PCP for advice. Your PCP must coordinate any urgent care and follow-up care you get.
If your doctor isn't available and you can't wait to talk with your PCP/return to our service area:
You can set up a virtual visit with a doctor 24 hours a day, or you can go to an out-of-network urgent care center or hospital for treatment. Careful! If they bill us for routine care instead of "urgent care", your plan may not pay for your treatment.
Your plan will only pay the "reasonable and customary" cost for services you get from out-of-network providers. They may bill you for the difference.
After you get urgent care, you must call your PCP's office to coordinate follow-up care.
Another option, if you're more than 100 miles from home
Most Priority Health members are also protected with free emergency assistance around the world because most plans* include 24/7 help from Assist America. Learn more about Assist America.