Emergency and urgent care

What is an emergency?

A medical emergency is a sudden unexpected illness or injury that you believe would place your life in danger or cause serious damage to your health if you do not seek immediate medical treatment. Medical emergencies include, but are not limited to:

  • Heart attack
  • Acute abdominal pain
  • Stroke
  • Severe chest pain
  • Poisoning
  • Loss of consciousness
  • Bleeding that does not stop
  • Medically necessary detoxification

In an emergency, always seek medical care immediately. Go directly to the nearest emergency facility or call 911. You and your covered family members can receive emergency medical services anywhere, 24 hours a day, even when you're away from home.

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What is urgent care or immediate care?

Many situations are not emergencies, but do require immediate medical attention. Urgent care is treatment you need right away for an illness or injury that is not life threatening, but you cannot wait for a doctor's office appointment.

Some conditions for which urgent care would be appropriate include:

  • minor cuts or burns
  • ear, nose and throat infections
  • sprains or strains
  • stomachaches
  • headaches or dizziness

Many urgent and immediate care clinics open early, close late and have weekend hours. If you are in doubt of what to do, call your doctor or ProvRN for advice. When you call ProvRN, registered nurses assess your symptoms and help you figure out your next steps for care. Call ProvRN 24/7 at 800-700-0481 (TTY: 711) for nurse advice. This free service is available exclusively to Providence Health Plan members.

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Not sure what to do?

Call your doctor's office if you are not sure what to do. Your doctor or an on-call doctor is always available and will tell you what to do and where to go for the most appropriate care.

You can also call ProvRN for nurse advice, 24-hours a day, seven days a week. Registered nurses assess your symptoms and help you figure out your next steps for care. Call ProvRN at 800-700-0481 (TTY: 711). This free service is available exclusively to Providence Health Plan members.

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Emergency and urgent care benefits

Your benefits cover emergency services in any hospital emergency room when your medical condition meets the guidelines for emergency care. Coverage includes services to stabilize an emergency medical condition and emergency medical screening exams.

For specific details about your emergency and urgent care coverage, refer to your benefit summary and member handbook. You can register and log in to myProvidence to access your benefit information.

You are responsible for your copayment/coinsurance at the time you receive services, unless you are admitted to a hospital within 24 hours. If you receive services from a non-participating urgent care clinic or emergency facility, you must submit a claim if the facility or provider does not submit it for you.

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Emergency and urgent care benefits while traveling

Your benefits cover emergency and urgent care at home or while traveling, including international travel. You and covered family members can go to the nearest hospital or qualified practitioner for emergency or urgent care treatment.* If you are admitted to a non-participating hospital, we must be notified within 48 hours or as soon as reasonably possible. Follow-up care is subject to plan limitations.

*Please note: You may be responsible for paying in full for health care services received at time of treatment. You can submit a medical claim form (PDF) with necessary documentation for reimbursement. Refer to your benefit summary for copayment/coinsurance amounts and any deductibles you may be responsible for.

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Search emergency and urgent care facilities

Search the Provider Directory. Click "Facilities" at the top of the page then click "Urgent Care" or "Hospitals." You can also enter your ZIP code in the right hand column to find locations near you.

You can call the urgent care or immediate care facility you wish to visit to verify hours of operation and when they stop accepting patients for the day.