BSWHP will provide benefits for medically necessary emergency care whether you are temporarily out of the service area or within the service area. Emergency care is defined as the sudden and unexpected onset of a condition of such a nature that a prudent layperson, possessing an average knowledge of medicine and health, believes their health could be jeopardized if they do not get immediate treatment. BSWHP will approve or deny the requested post-stabilization treatment within one hour if contacted by the provider or facility. Some examples of emergency conditions include the following:
- Unusual or excessive bleeding
- Broken bone
- Acute abdominal or chest pain
- Loss of consciousness
- Suspected heart attack
- Sudden persistent pain
- Serious burn
- Difficulty in breathing
In all emergency situations, you are encouraged to seek care with the nearest BSWHP-approved provider; however, if the time needed to reach a BSWHP-approved provider might endanger your health, go to the nearest emergency room. Medically necessary emergency care is covered. If you are hospitalized as a result of the emergency, you should contact the BSWHP Health Services Division within 24 to 48 hours of any admission at 888.316.7947. Coverage for continued treatment is assured when approval is obtained from the BSWHP Medical Director through the Health Services Division. Emergency care in a hospital emergency room requires a copay, which will be waived if hospital admission occurs within 24 hours.
While a medical emergency is considered a life-threatening condition, urgent care is considered less severe than an emergency, but requiring care more quickly than elective care. Urgent care includes, but is not limited to, sudden illnesses and injuries, lacerations and fever. BSWHP encourages you to access one of its Urgent Care Clinics if you find yourself needing urgent care after hours. If you do not know when to access an Urgent Care Clinic, please contact a BSWHP nurse through our Nurse Advice Line at 877.505.7947.