Using the Emergency Room

What is an Emergency?

An emergency is a health problem that is life-threatening or one that will seriously affect your health if not treated immediately.  An emergency is defined as the sudden onset of a medical condition that manifests itself by acute symptoms of sufficient severity or severe pain such that a prudent layperson who has an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in:

1. placing the health of the member, or in the case of a pregnant woman, the health of the woman or her unborn child in serious jeopardy;
2. serious impairment to bodily functions; or
3. serious dysfunction of any body organ or part.

An emergency can result from an accident or sudden illness that puts you in danger of death or severe injury.

Examples of emergencies include:

What should you do if you have an emergency?

1. Go to the nearest Emergency Room.
2. Call 911 for an ambulance if you cannot get to the Emergency Room on your own.
3. You do not need approval from AmeriHealth Mercy to to receive care in an emergency.
4. If you have an emergency away from home, follow the same guidelines.

If you are not sure you have an emergency, always call your Primary Care Doctor first. He or she can help you decide if you need to go to the nearest Emergency Room.

Remember

For follow up care after an Emergency Room treatment, contact your Primary Care Doctor.  Do not go back to the Emergency Room where you were treated unless your Primary Care Doctor refers you.

What is Urgent Care?

Urgent Care is care that is serious but is not an emergency. It requires attention from a doctor but not in the Emergency Room. Call your Primary Care Doctor and follow his/her advice. Your Primary Care Doctor can help you decide if you need to go to the Emergency Room.

If you call your Primary Care Doctor after hours and the office is closed, you will get the doctor's answering service. Leave your name and number and the doctor's office will call you back.

What are examples of Urgent Care?

If you need this translated into another language, please call Member Services at 1-888-991-7200. Si usted necesita que esto sea traducido a otro idioma, por favor llame al Servicio para Miembros al 1-888-991-7200.

For members with a hearing impairment, please call the TTY Line at 1-888-987-5704.

Questions? If you have any questions about AmeriHealth Mercy, call us. You can talk to a Member Services Representative 24 hours a day, 7 days a week at 1-888-991-7200.

Member Services
1-888-991-7200
TTY: 1-888-987-5704

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