3 Is It Really An Emergency?

If you don’t have a primary care doctor, choose one today. Your relationship with your doctor is vital to ensure your good health and to promote preventive care.  An advantage to using your doctor rather than an ER is that your doctor will have your medical history, including your allergies to certain medications, and is able to offer you the same or higher level of quality care for non-emergency injuries or conditions than is offered in an Emergency Room.  Establishing a relationship with a regular primary care doctor (an internist, family practitioner, or gynecologist) and with a pediatrician for your children will keep you healthy and help control the rising costs of health care.

Only choose Emergency Rooms for life-threatening situations in which you need immediate care and where your life is in jeopardy.  In other words, the Plan covers you for emergency room visits ONLY IF YOU HAVE A TRUE EMERGENCY, such as a life-threatening illness or accident.  Do not use emergency rooms for routine care or as a substitute for a doctor’s office.
Examples of types of illness where you or an eligible dependent might need to use an emergency room include:

  • Acute appendicitis attack
  • Asthmatic attack
  • Convulsion
  • Heart failure
  • Broken bones
    Any treatment received in an emergency room for other than a life-threatening illness or injury will be regarded by the Fund as “regular medical treatment” and will not be covered.  You will be responsible for the charges.  Examples of conditions that generally are not true emergencies include:

  • Headache
  • Sore throat
  • Ear pain
  • Flu
  • Severe food poisoning
  • Uncontrollable bleeding
When in doubt, call your doctor’s office and ask for advice.  (Most doctors are reachable or have coverage in event their patients need to reach them after hours.)  Ask what you can do to care for yourself or your dependent and if the symptoms are ones that can wait for an office visit as opposed to requiring the immediate attention of an emergency room.