Getting urgent care with your POS plan

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

In our service area

First call your primary care doctor or other primary health care provider ("PCP"), if you have one. A PCP knows their patients' medical histories 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.

OR

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. 

To use Find a Doctor:

  1. Log in or create a member account
  2. Select Find care in the top menu
  3. Click Find a doctor or specialist.

    4. Note that out-of-network PCPs or specialists must be authorized before a visit (called “prior authorization”). Your in-network PCP can help coordinate all referrals to specialists.

Call your PCP's office as soon as possible to coordinate follow-up care.

If you go to an urgent care center that is not in your plan's network

  • Unless you are outside the Priority Health service area, you'll pay your higher "alternate benefit" copayment or coinsurance to go to an out-of-network urgent care center.
  • Any follow-up care from the same out-of-network provider will also cost the higher out-of-network copayments/coinsurance.

Outside our service area

If you have to go to an urgent care center when traveling, you will pay your "preferred benefit" copayment or coinsurance. 

Just be sure to let your PCP know about your visit, so he or she can coordinate any follow-up care you might need.