High Level Care for High Level Needs: 2 Choices for Immediate Care

High Level Care for High Level Needs: 2 Choices for Immediate Care

We've shared an overview of the choices you have when small, but urgent health care matters come up.  Need a refresher? You can review. Now let’s talk about being ready if something more serious comes your way.

How do you know if you should go to an emergency room (ER)? Here’s a little ditty to help you decide: “If it could be the end of me, an ER is where I need to be.”

In other words, if it’s pretty clear that a medical condition is life threatening, then you probably need to go to the nearest emergency room. Some examples of emergency care include having chest pain or other signs of a heart attack or stroke, a deep wound that is bleeding heavily, a severe burn, or a serious head, neck or back injury.

These and other serious conditions should always be treated at the ER. Call 911 for an ambulance or have someone take you to the nearest ER.

Keep in mind there is more than one kind of ER. Here are your options:

Hospital ER – If you know which nearby hospitals are in your health plan’s network, you can ask the ambulance driver to take you there. If not, you'll be taken to the closest ER or one best equipped to take care of your emergency.

Freestanding ER - Not all ERs are located at hospitals. If the word EMERGENCY is part of a facility name, chances are you’re at an ER, even if it isn’t part of a hospital. Freestanding ERs are equipped like an ER and are staffed with ER doctors. They treat many life-threatening or disabling conditions.

Be aware that costs for services at freestanding ERs may be much higher than other options. In fact, the costs can be as much as if you went to the ER at a hospital. Unless the facility is part of a bigger hospital system, it may not be in your health plan’s network. Many don't contract with insurance providers.

Here are some ways to know if you're at one. Freestanding ERs are:

  • Designed to look like urgent care centers, but include EMERGENCY in the facility names.
  • Open 24 hours a day, seven days a week.
  • Physically separate from any hospital.
  • Subject to the same copay as a hospital ER and are staffed by ER physicians.
  • Often more expensive than a hospital ER.

When you get ER care, your copay and out-of-pocket costs will likely be higher than a trip to see your doctor. They'll be even higher if you see an out-of-network provider.

Here are a few things you can do to help keep your out-of-pocket costs as low as possible when an emergency happens.

Be Prepared
  • Take some time now to educate yourself and prepare for a possible ER visit.
  • Find your nearest in-network hospital emergency room. Use our online tool to find an in-network ER near you. Log in to Blue Access for MembersSM, your online member account, and go to Find Care to locate network providers and hospitals.

Remember, if it isn’t an emergency, call your doctor or go to an urgent care center instead.

Life and death situations don’t happen often, but if you ever need an ER, you’ll know how to make the best choice for care. If you have questions about what your health plan covers, call the number on your BCBSTX member ID card.

Originally published 12/23/2014, Revised 2019; 2022, 2024

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