Emergency, Urgent and Follow-Up Care

What are Emergency Services?   |   What is Urgent Care?
Emergency Services Inside and Outside Keystone’s Service Area   |    Payment for Immediate Care Services   |   Medical Screening Evaluation   |   Follow-Up Care Benefits   |   Auto or Work-Related Accidents

What are Emergency Services?

“Emergency Services” are any health care services provided to a member after the sudden onset of a medical condition. The condition manifests itself by acute symptoms of sufficient severity or severe pain, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

	A.		placing the health of the member or with respect to a pregnant female, the health of the member or her unborn child, in serious jeopardy;
	B.		serious impairment to bodily functions; or
	C.		serious dysfunction of any bodily organ or part. Emergency transportation and related emergency services provided by a licensed ambulance service shall constitute an emergency service.

Emergency Services do not require a referral for treatment from your primary care physician.

	NOTE: If you believe you need emergency services, you should call 911 or go immediately to the emergency department of the closest hospital.