Emergency Coverage

Benefits for emergency room care are not provided if your medical condition does not meet Blue Cross Blue Shield’s criteria for “emergency care.” Therefore, it is important for you to know the difference between urgent and emergency care under Network Blue New England.

Urgent care is care that can safely be postponed for the time it takes to contact a physician for instructions on obtaining treatment. Examples might include a sprained ankle or an earache.

If you or a covered family member require urgent care when you are within the service area, you must contact your primary care physician (PCP) (or the physician covering for your PCP) who will provide or authorize care at an appropriate facility. If you are more than 25 miles from your home, you should obtain treatment at the nearest facility and contact Network Blue within 48 hours or on the next business day (whichever is sooner) in order to receive full plan benefits.

Emergency care is a medical “emergency” that requires immediate care in order to save a life or prevent permanent impairment. Emergency care is typically sought for an accidental injury or the sudden onset of an acute medical condition. Examples might include a suspected heart attack or stroke.

In an emergency—whether in or outside the network service area—you should obtain treatment at the nearest facility and notify Blue Cross Blue Shield within 48 hours or on the next business day (whichever is sooner) in order to receive full plan benefits.

You will have to pay a $50 copayment  each time you use a hospital emergency room. If an emergency room visit results in a hospital admission within 24 hours, the $50 charge will be waived.