Medical Emergencies and You

“Expect the best but plan for the worst”, may not be a bad saying. People don’t often think about evaluating their emergency health plan. Sometimes, a visit to an emergency room is the first time people get acquainted with the emergency benefits of their insurance plan. Here are some key things to be aware of, to help determine the quality of your emergency plan, and also, to keep you well-informed so you know what to anticipate in the event of a medical emergency. If you do not already have health insurance, visit Affordable Medical Insurance for some helpful information.

What is a Medical Emergency?
In very general terms, a medical emergency would be a situation that presents a threat to life or limb, if immediate medical attention is not obtained. An emergency also includes a psychiatric condition which puts you or someone else in harm’s way, if it’s not addressed immediately. Most emergency insurance plans will cover you anywhere in the world, providing it’s a true emergency. Some common examples of a medical emergency are: shortness of breath, unconsciousness, bleeding that won’t stop.

What to Look for in an insurance plan
If you are relatively healthy and rarely need medical care, then you are probably what High Deductible Health Plans (HDHP) were designed for. By and large, these policies give you catastrophic coverage. This means you pay out-of-pocket until what you have paid adds up to the deductible amount. When the deductible is reached, you may also have to pay a percentage of the remaining cost or a flat fee, depending on your particular insurance policy provisions. If you prefer a plan with a little more peace of mind with regards to your out-of-pocket costs, then consider a standard deductible plan with a lower deductible or a copayment plan with little or no deductible requirements.

When comparing plans, look at three basic features: the deductible size, the maximum out-of-pocket amount, and the premium. In the event of an emergency or other major medical incident, it may help to know that most hospitals will work with you on a payment plan. Usually, you won’t be expected to come up with the payment all at once. If you are admitted, the treating hospital will give you more information.

What to do in the Event of an Emergency
Call 911 or go to the closest medical facility. If you call 911, the dispatcher will assess the severity of the condition and prioritize the emergency.

Emergency Ambulance Service
On most, if not all health insurance plans, emergency ambulance service is a separate benefit from an emergency room visit, or hospitalization. For example, if you are on the Kaiser Permanente $30/1500 Deductible Plan in California and you have a medical emergency that costs $5,000 for the emergency room services and $1,000 for the ambulance service, the total cost will be $6,000. You would be responsible for the $1,500 deductible, plus a copayment of $150 for the emergency department and a separate copayment of $150 for the ambulance service.

What if Someone Else is in an Emergency?
What if you’re driving and there’s an auto accident in front of you? Call 9-1-1, and if possible, help accident victims from further injury. Some people hesitate to help for fear of legal liability; however, many states have what’s called, the “Good Samaritan” law, which protects non-professional emergency responders from getting sued. The laws are meant to help a bystander help a person in need.

The Good Samaritan laws vary from state to state. In general, the volunteer responder is required to stay with an injured victim unless doing so presents a danger or the civilian becomes too exhausted to continue. The civilian is excused when trained professionals, like firemen and paramedics, arrive. If you should ever find yourself in a position to be a Good Samaritan for someone in an emergency, you may find yourself needing the same kindness at some point. Either way, we can all be thankful for the professional emergency responders that do this on a daily basis.

Emergency Room Process
If you have an emergency and are taken to the emergency room, a technician will assess your condition and prioritize the level of care you need. Depending on the severity of the condition, you will, generally have whatever exam, treatment, and lab work or x-rays are needed to stabilize your condition. For Kaiser Permanente members who are treated at a Kaiser facility, you will receive a single bill for services received at the emergency room department. If you are treated at a non-Kaiser facility, which is fine, you will likely receive a bill from multiple service providers.

While your emergency situation is not stable, the “Emergency Care” section of your insurance policy will be in effect. Kaiser Permanente health plans cover you for emergency care services whether you are treated at Kaiser Permanente or a non-Kaiser facility, anywhere in the world. Pre-authorization is not required for emergency situations, but when it is reasonably possible, contact your insurance company right away.

Post Stabilization Process
Once your condition is stable, then, your coverage may become subject to the “Post Stabilization Care” section of the policy, not emergency care. In this stage of the process, be sure to contact your insurance company as soon as possible.

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