![]() You follow the other rules described in this chapter.You get this care from a network provider, and.In most situations, we will cover urgently needed care only if: Getting urgently needed care when you are in the plan's service area For example, you might have a flare-up of an existing condition and need to have it treated. Urgently needed care is care you get for a sudden illness, injury, or condition that isn't an emergency but needs care right away. Getting urgently needed care What is urgently needed care? The additional care you get is considered "urgently needed care" and you follow the rules for getting this care. ![]() However, after the doctor says it was not an emergency, we will cover your additional care only if: ![]() As long as you reasonably thought your health was in serious danger, we will cover your care. You might go in for emergency care and have the doctor say it wasn't really a medical emergency. Sometimes it can be hard to know if you have a medical emergency. What if it wasn't a medical emergency after all? If you get your emergency care from out-of-network providers, we will try to get network providers to take over your care as soon as possible. ![]() Your follow-up care will be covered by us. Medi-Cal coverage is limited to the United States and its territories, except for Emergency Services requiring hospitalization in Canada or Mexico.Īfter the emergency is over, you may need follow-up care to be sure you get better. In these situations, Medicare will pay only for the Medicare-covered services you get in a foreign hospital. hospital that can treat your medical condition, regardless of whether it's an emergency. and the foreign hospital is closer to your home than the nearest U.S. Medicare determines what qualifies as "without unreasonable delay" on a case-by-case basis. hospital that can treat your illness or injury. You're traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S.when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. There are three situations when Medicare may pay for certain types of health care services you get in a foreign hospital (a hospital outside the U.S.): There are some exceptions under Medicare as follows: For more information, see “Worldwide Emergency/Urgent Coverage” in the Benefits Chart in Chapter 4 of the Member Handbook.įor members enrolled in San Diego County, coverage is limited to the United States and its territories: the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. This benefit is limited to $50,000 per year. To learn more, see the Benefits Chart in Chapter 4 of the Member Handbook.įor members enrolled in Los Angeles County, you may get covered emergency medical care outside the United States. If you need an ambulance to get to the emergency room, our plan covers that. You may get covered emergency care whenever you need it, anywhere in the United States or its territories. What is covered if you have a medical emergency? Your call will be returned within the next business day. After hours, on weekends and on holidays, you can leave a message. Contact Member Services at 1-85 (TTY: 711) for Los Angeles County and 1-85 (TTY: 711) for San Diego County. You or someone else should call to tell us about your emergency care, usually within 48 hours. ![]()
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