This article is intended for HMO members.

When someone becomes suddenly ill or injured, you want to get help right away. But it pays to stop for a second and think about what kind of care and facility is best.

There are certain immediate health problems that should be handled in the emergency room. But less serious injuries or illnesses can be taken care of at an urgent care facility.

Use the list below as a reference for deciding which facility to visit. If you’re unsure, call our 24/7 Nurseline at 800-581-0407. Use your best judgment, and always call 911 in case of an emergency or life-threatening situation.

Emergency Care

If you need emergency care, seek aid at the nearest appropriate facility. Call your primary care physician (PCP) within 48 hours of the event. Only seek emergency aid for real medical emergencies, as defined in your member handbook.

Consider seeking emergency room care for symptoms such as:

• Chest pain
• Trouble breathing
• Severe bleeding
• Head injury
• Loss of consciousness
• Sudden loss of vision or blurred vision
• Sudden dizziness, facial drooping or weakness in an arm or leg
• Major broken bones
• Allergic reactions (life-threatening)
• Seizures
• Coughing or vomiting blood
• Severe or persistent vomiting or diarrhea

Urgent Care

Go to an urgent care facility when you have an unexpected injury or illness that is not an emergency but is severe enough to require aid and treatment within 24 hours.

If you think you need to visit an urgent care facility, consider checking with your PCP first. Your PCP may recommend a method of home care, ask you to come to the office or suggest that you go to an emergency room.

Keep in mind that urgent care provided by an emergency room instead of an urgent care facility without preauthorization from your PCP will not be covered.

Urgent care facility treatment may be appropriate for symptoms such as:

• Minor burns or injuries
• Sprains and strains
• Earaches
• Minor allergic reactions
• Fever
• Flu-like symptoms
• Rash or other skin irritations
• Animal and insect bites
• Minor broken bones
• Minor cuts and lacerations

If you have more questions, please call the customer service number on your member ID card.

Originally published 7/1/2020; Reviewed 2021, 2022