Urgently Needed Care
While your primary care physician or other treating physician is the preferred first point of contact for care, urgent care is an important alternative to going to the hospital emergency department for non-life threatening conditions and provides immediate medical treatment for minor and moderate illnesses and injuries.
Covered Urgent Care Services
Urgent care is covered anywhere in the United States and does not require a referral. If you need care when you are outside the service area (within the United States), your coverage is limited to medical emergency, urgently needed care, renal dialysis or services that our health plan has approved in advance.
If you get non-emergency care from out-of-network providers without prior approval, you may have to pay the entire cost yourself, unless the services are urgent and our network is not available, or the service is out-of-area dialysis. If an out-of-network provider sends you a bill that you think we should pay, you should send the bill to us for processing and determination of liability.
Please contact Customer Service for more information at 1-877-388-5195 or for TTY, 711.
Our hours are 8:00 a.m. to 8:00 p.m. seven days a week from October 1 to March 31, and 8:00 a.m. to 8:00 p.m. Monday through Friday from April 1 to September 30.
Getting Care in a Medical Emergency
A “medical emergency” is when you have medical symptoms that require immediate medical attention to prevent loss of life, loss of a limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain, or a medical condition that is quickly getting worse.
If you have a medical emergency:
Get help as quickly as possible. Call 911 for help or go to the nearest emergency room or hospital. You do not need to get approval or a referral first from your primary care provider.
Call for an ambulance if you need it. You do not need to get approval or a referral first from your primary care provider.
As soon as possible, make sure that our plan has been told about your emergency so we can . follow up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours by calling Customer Service at 1-877-388-5195. TTY users should call 711. The Customer Service contact numbers can be found on the back of your member identification card. Our hours are 8:00 a.m. to 8:00 p.m. seven days a week from October 1 to March 31, and 8:00 a.m. to 8:00 p.m. Monday through Friday from April 1 to September 30.
What is covered if you have a medical emergency? You may get covered emergency medical care whenever you need it, anywhere in the United States or its territories. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health.
If you have an emergency, we will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stabilized, and the medical emergency is over.
After the emergency is over you are entitled to follow-up care to ensure your condition stays stable. Your follow-up care will be covered by our plan. If your emergency care is provided by out-of-network providers, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow.
Out-Of-Network Coverage Rules
Integra Managed Care does not cover out-of-network services unless previously authorized by our care management team, with the exception of emergency and/or urgent care accessed outside of our service area. When you are outside the service area and cannot get care from a network provider, our plan will cover urgently needed care that you get from any provider.
2021 Plan Documents