Emergencies and urgent care

Jump to:

• Urgent care
• If you're more than 100 miles from home

Emergency care

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.

First, 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,

• When you get emergency care services from a provider 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. Learn more about balance billing.

Then call your PCP

If you are hospitalized following a medical emergency, call your primary care provider (PCP) or other primary health care provider's office as soon as possible, or you can have someone call for you.

• Your PCP will coordinate any follow-up and continuing care with in-network providers.
• 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.

Examples of emergencies

Urgent care

An urgent medical problem is not life-threatening but must be treated in the next 24 hours to keep it from getting worse.

If you're in your plan's network area

Call your primary care provider (PCP) or other primary health care provider if you have one. If your doctor isn't available and you cannot wait, you can set up a virtual visit or go to an urgent care in your plan's network.

• You can access virtual care through your online member account.
• Use our online Find a Doctor tool to find an in-network urgent care center.
• Urgent care will usually have a higher copayment than a regular doctor visit.
• 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.
• Call your PCP's office as soon as possible to coordinate follow-up care.

If you're outside your plan's network area

Call your PCP for advice. If your doctor isn't available and you cannot wait, you can set up a virtual visit or go to an out-of-network urgent care.

• You can access virtual care through your online member account.
• If you have a narrow network plan, your plan will not pay for care outside your network unless it's an eligible emergency service.
• Your plan may not pay for your treatment if they bill us for routine care instead of urgent care.
• 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.
• Call your PCP's office as soon as possible to coordinate follow-up care.

If you're more than 100 miles from home

Assist America^® provides emergency travel assistance services for you and your dependents when traveling more than 100 miles from home or in a foreign country, for up to 90 consecutive days per trip. If someone becomes ill or injured, Assist America provides support with medical referrals, monitoring, evacuation, repatriation and much more.

Travel coverage with an HMO plan

With an HMO plan, you have to have a primary care physician (PCP) and in-network coverage. If you go to a doctor, rather than an urgent care or emergency center that is not in-network, you will pay 100% of the cost of your care.

If you are 100 miles or more away from your home and PCP for less than 90 consecutive days, Assist America will provide emergency travel assistance support while you're away.

Assist America's features and advantages

• Free to MyPriority^® plan members
• Covers the costs of all travel assistance services related to getting quality emergency medical care while traveling, such as medical referrals, critical care monitoring, emergency evacuation and other support measures
  Note: Once a qualified doctor or hospital begins providing care, all treatment costs are subject to the coverage rules of your health plan. Medical service costs are not covered by Assist America.
• Assists in finding a doctor or pharmacy near you while you're traveling
• Helps fill your prescriptions at your destination
• Assists in locating lost luggageAvailable everywhere in the world, regardless of geography or political climateAccess to multilingual, medically-trained employees anytime, anywhere
• Pre-trip information including visa requirements, immunization regulations and security advisories
• No financial cap on servicesNo exclusions for pre-existing conditions or extreme sports/hazardous hobbies

How to access services

Get help when you need it. Contact Assist America one of the following ways:

1. Download the app on Google Play and the App Store
2. Call 24/7:
   Within the U.S. 1.800.872.1414
   Outside the U.S. 1.609.986.1234
3. Text 1.609.334.0807
4. Email medservices@assistamerica.com

Reference number

When contacting Assist America, provide the reference number:

• MyPriority members: 01-AA-PHP-12123

Assist America is a registered service mark of Assist America, Inc.