Tag Archives: FAQ

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.

Don't Miss Your Deadline!

The End is Near: March 31, 2014

NPHIt’s crunch time, and tomorrow may be too late. We know you understand the definition of a deadline, but what happens if you miss March 31? In short, nothing good!

Let’s run through a few questions you might have about what this deadline really means and why waiting might mean less money in your bank account.

What happens if I don’t enroll in a plan by March 31?

After the deadline, an individual can no longer enroll in a plan. You’d have to:

  • Wait until the next Open Enrollment Period (in Fall 2015)
  • Qualify for a Special Enrollment Period (for example, marriage or the birth of a child).

On top of that, you have to pay a tax penalty. And that doesn’t mean you’re covered, you’ll still have to pay 100% of your medical costs!

If I wait until the end of March to enroll, will I have to pay the tax penalty? I’ve heard if my gap in coverage is more than 3 months, I still have to pay.

As long as you’ve completed the application process by March 31, an exemption will keep you from having to pay a penalty on your 2015 tax returns.If you want to learn more about this exemption, visit the CMS’s Enrollment Period FAQ.

Does enrolling in a Short-Term plan save me from the tax penalty?

No. Individuals on short-term plans will pay the penalty on their 2015 tax return (unless they meet an exemption).

Can I change my plan after March 31?

No. You’ll have to wait until the 2015 Open Enrollment Period to make changes to your plan.

The only exception to this rule is adding a newborn. You have about a month to add your new little bundle of joy to your plan.

You can cancel your plan at any time, but depending how long you go without coverage, you may have to pay a penalty.

How will the government really know whether I have insurance?

Great question. When you submit your federal taxes in 2015, the forms will have a new question about health insurance coverage. Health insurance companies, like Health Alliance, will also have to send the IRS info about who has a coverage with us.

You still have time to enroll in a plan.  And we’re here to help you find one that fits your needs (yes, even if it’s in the last 10 minutes!)

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