HMO Guide for Seniors - Office of the Patient Advocate - State of ...

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Emergency Care
I
n an emergency, you should call 9-1-1 or go to the nearest
emergency room. If you can, go to a hospital in your Medicare
HMO’s network. However, any emergency room must treat you.
Medicare HMOs must cover emergency care anywhere in the U.S.
What Is an Emergency?
In general, it is an emergency if you think your health is in serious
danger and you need care immediately. Examples of emergencies
include a bad injury, a sudden illness, an illness that is quickly getting
much worse, shock, a severe wound, a heart attack, or severe pain.
Urgent or After-Hours Care
If you need care quickly but it is not an emergency, call your doctor
and ask for a same-day appointment. Or go to an urgent care clinic
if your HMO has one. Medicare HMOs cover urgent care, even if
you are outside your HMO’s area.
If your Medicare
HMO will not
pay for your
emergency care,
you can file an
appeal. See
page 58.
Try not to use the emergency room if you do not need to. Your
HMO may not pay for your visit if it is not an emergency. Your
co-pays can be high, and your wait can be long. And it is usually
better to see your own doctor, who knows your health care needs
and has your medical records.
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