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What You Need to Know About Urgent and
Emergency Care

An urgent or emergency medical condition can be frightening, especially when you do not know what to do or where to go. That is why it is important to know how to access urgent or emergency care before the need arises.

What is an URGENT medical condition?

Sprained ankles, most burns, minor wounds requiring stitches, back pain, chronic headaches, urinary tract infections and severe cold or flu are typical examples of urgent conditions. An urgent condition:

• Is not life threatening but may require prompt attention
• Requires care on the same day or next day depending on the severity of the condition

What is an EMERGENCY medical condition?

A medical emergency occurs when you reasonably believe that your health is in serious danger and every second counts. A medical emergency includes:

• Severe pain
• A bad injury
• A serious illness
• A medical condition that is quickly getting much worse

Emergency care is available 24 hours a day, seven days a week at emergency facilities. If you experience a medical emergency, go to the nearest emergency facility or call 911 for assistance.

Why is it important to know the difference between urgent and emergency conditions?

Knowing the difference between urgent and emergency medical conditions will help you determine how to obtain the most appropriate care, can save you costly copays and can ensure that you are treated as quickly as your condition requires.

What should I do when I am traveling?

Many of our plans offer worldwide health care coverage for medical emergencies, accidental injuries and urgent care. Remember that in an emergency situation you can always call 911 in the United States or go to the nearest emergency room.

Generally, the site where you seek care will ask for your health insurance card (your HAP or Alliance ID card) and call the number on the back for billing or coverage questions. If the physician or hospital does not recognize your ID card and requires immediate payment for services, you are responsible for paying the hospital or physician. We will fully reimburse you for the covered services less any copays you are required to pay. Just send your receipts to:

Health Alliance Plan
Attention: Member Reimbursement
2850 W. Grand Blvd.
Detroit, Michigan 48202

Medical Services Reimbursement Form (need link)

If you are admitted to a hospital not affiliated with us, you or your designee should notify us within 48 hours at the number listed on the back of your ID card.

Click to review a complete list of approved Urgent Care Centers. (need link)

Please refer to your plan's Evidence of Coverage (need link) for complete benefit information.

Assist America®

As a member of HAP Senior Plus, Alliance Medicare PPO and Alliance Medicare Supplement, you also have the added protection of global emergency services provided by Assist America®.

Travel with confidence

Through our partnership with Assist America, whenever you travel 100 miles or more away from home or to another country for up to 90 days, you have access to safe and reliable emergency assistance resources throughout the world and protection against expenses that can result from medical emergencies.*

Learn more at www.assistamerica.com/hap.

Assist America does not replace your Medicare coverage.* You are covered for urgent and emergency care based on your member contract.

Assist America services are neither offered nor guaranteed under our contracts with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these services may be subject to the HAP grievance process. These services are not included in the Alliance Medicare Rx (pdp) plan.

 
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