Tag Archives: copay

In Case of Medical Emergency

Long View: What Is a Medical Emergency?

According to Medicare.gov, a medical emergency is a situation where “[Y]ou believe you have an injury or illness that requires immediate medical attention to prevent a disability or death.”

It seems pretty straightforward, so why are there so many questions around the decision to get treatment at your local emergency room?

An emergency room (ER) provides some of the most sophisticated diagnostic options in a hospital and the most immediate care to patients in crisis.

The list of possible emergencies is endless, so it’s important for you to recognize how serious your injury or illness is and to know the best way to get treatment for it.

Many of us have heard about folks with medical emergencies driving themselves to get treatment or catching a ride with a family member. Please don’t. Driving yourself puts you and others in jeopardy and delays the start of your treatment. Dialing 911 brings you the treatment quickly and gets you to an emergency room faster than a white-knuckle trip across town, dodging traffic lights.

Dr. Frank Friedman, one of our medical directors who specializes in emergency care, said, “A true emergency is one that can’t wait. It is something causing such severe pain or such a risk to life or limb, for oneself or a loved one, that it can’t wait hours, or a day or two, to be seen by one’s own doctor or healthcare provider.”

If it’s not an emergency but you need medical care to keep an illness or injury from getting worse, call your doctor. If your doctor can’t see you right away or the office is closed, urgent care (or convenient care) can help you get treatment quickly.

Over the years, I have heard some interesting and alarming questions from our members. This FAQ can help answer those questions.

Q. I just got one of your policies, and I’m having severe chest pain. Will you cover me for an ER visit?

A. This is one of the most unsettling questions we receive. If you’re experiencing severe chest pain, don’t call your plan, call 911. It’s as simple as that.

Q. Do I have to pay a copay when I get there?

A. No, they should be able to bill you, so there’s no reason to wave your credit card around as they wheel you through the front door. In fact, under federal law, an ER has to evaluate and stabilize you in an emergency medical situation, without regard for your ability to pay.

Q. What if I have special conditions they need to know about?

A. Keep a list of your medications with you. MedicAlert’s medical IDs or the Yellow Dot program can also help you share this information. And many smart phones have features that let you add emergency contacts and medical information. Plan ahead.

Q. What are some examples of when I should go to the ER and when I should go to my doctor or urgent care?

A. Visit the ER for emergencies like chest pain, broken bones, poisoning, shortness of breath, fainting, and seizures. For things like a constant fever, strep throat, sprains, the cold or flu, earaches, or minor infections like pink eye, call your doctor or visit urgent care.

Will you recognize a medical emergency? Probably yes, so trust your judgment, act quickly, and please be careful out there.

Patrick Harness is a community liaison with a long history of experience in health insurance. If you ask him to pick a color, he always chooses orange, and he is known for his inability to parallel park.

Good Health at Any Age

Vantage Point: May Good Health Bless You this Holiday Season

Some of us were lucky to be born with good health, but keeping that health is a challenge, especially as we age. My coworkers recently invited me to do a “Maintain, Don’t Gain” holiday challenge. At first I thought I didn’t want to limit myself during the holidays—when good food, drinks, and sweets are everywhere—but as the days got shorter and I started making excuses to skip my workouts (too dark, too cold, too tired, etc.), the scale and my health started moving in the wrong direction.

Health Alliance Medicare is more than a health plan that covers our members when they get hurt or sick. It offers programs to manage chronic diseases and wellness benefits to help our members stay healthy all winter long—no matter how cold and dark the days get.

One of our most popular benefits is the SilverSneakers® fitness program that gives members free gym access at participating gyms or sends workout equipment right to their home. I have watched a SilverSneakers class at the Wenatchee YMCA. The participants there not only get a great workout that improves strength, balance, and flexibility, but they also have fun, laugh, smile, and socialize.

Health Alliance Medicare works to prevent illness, too. We offer our members flu and other vaccines. At the Ephrata Community Resource Forum, Jeff Ketchel, administrator of Grant County Public Health, highlighted the importance of the flu shot now that flu season is here. The flu shot is key to keeping you and your loved ones healthy through the holidays and beyond. Members can get the flu vaccine at in-network providers or pharmacies.*

Recently, one of our employees was sitting next to a gentleman making small talk, and he learned she worked for Health Alliance. He took her by the arm and said, “Thank you, we absolutely love your plan.”

In that same spirit, I thank all of you for allowing Health Alliance to partner with you to improve the health of the communities we serve, and I wish you and your families a healthy and happy holiday season.

*If a member gets the flu vaccine at a doctor’s office, an office visit copay may apply.