What are emergency conditions and services?

An emergency condition is when you are experiencing extreme or sudden pain or have acute symptoms that require immediate medical diagnosis, care and treatment to avoid disability or death.

Emergency services are those required for an acute medical condition in which a prudent layperson could reasonably expect the absence of immediate medical attention to result in serious jeopardy or harm.

If you have an emergency situation, call 911 or go to the nearest emergency room no matter where you are located. You do not need pre-approval from your physician for initial ER care, but related follow-up care should be provided through your primary care physician.

What are urgent care conditions and services?

Urgent care means services that are medically required within a short-time frame, usually within 24 hours, in order to prevent serious deterioration of a member's health due to an unforeseen illness or injury.

How do I get urgent or after-hours care?

If you need medical services after your doctor’s office is closed, follow these steps:

  1. Call your doctor’s office.  Your doctor or the doctor on-call will instruct you to seek care at the emergency room, your medical group's contracted urgent care center, or on home care remedies.
  2. Call Nurse24.  If you have a medical concern and are not sure what to do, you can call our nurse advice line at 877.793.3655. Nurse24 is available 24/7 so you can call any time of the day or night.
  3. Be prepared.  Know the contact information and location of the closest emergency room, your medical group’s urgent care center, poison control, and closest friend/relative.
Am I covered for urgent and emergency care?

WHA covers you for Urgent Care and Emergency Care services wherever you are in the world. Please note that emergency room visits are not covered for non-Emergency situations.

Urgent Care
If an Urgent Care situation arises while you are in WHA's Service Area, call your PCP. You can call your doctor at any time of the day, including evenings and weekends. Explain your condition to your PCP or the physician on call and he/she will direct your care. In the event you are not able to reach your PCP, you should go to an Urgent Care facility affiliated with your medical group.

Emergency Care
If an Emergency situation arises whether you are in WHA's Service Area or outside of the Service Area, call "911" immediately or go directly to the nearest hospital emergency room. If you are hospitalized at a non-participating facility because of an emergency, WHA must be notified within twenty-four (24) hours or as soon as possible. If you are unable to make the call, have someone else make it for you, such as a family member, friend, or hospital staff member.

Follow-up care after an emergency room visit is not considered an Emergency situation. If you receive Emergency treatment from an emergency room physician or non-participating provider and you return for follow-up care (for example, removal of stitches or redressing a wound), you will be responsible for the cost of the service. Contact your PCP for all follow-up care.

Visit Urgent and After-Hours Care to learn more.

What if I have an out-of-area emergency?

WHA covers you for urgent care and emergency care services wherever you are in the world. If you are hospitalized at a non-participating facility because of an emergency, WHA or your PCP must be notified within 24 hours of the emergency or as soon as possible. 

Please note that emergency rooms visits are not covered for non-emergency situations. Also, call your PCP for all follow-up care for your emergency treatment. If you return to the emergency room or non-participating provider for follow-up care (for example, removal of stitches or redressing a wound), you will be responsible for the cost of service.  If your emergency health problem requires a specialist, your PCP will refer you to an appropriate participating provider as needed.

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