Our Commitment to Compliance
Requires immediate face-to-face medical attention. Call 911 or go to the nearest ER.
Requires timely face-to face medical attention within 24 hours.
Requires face-to-face medical attention within 48 to 72 hours.
Requires a face-to-face visit within 4 weeks.
Medical care for a condition that, without immediate treatment, could result in:
Placing the member’s life or general health in severe jeopardy
Causing severe impairment in one or more bodily function(s)
Causing severe dysfunction of one or more body organ(s) or parts
Examples of emergency conditions include:
NOTE: If a practitioner is not available, the member should call 911.
Medical care given for a condition that, without timely treatment, could result in:
Deteriorating into an emergency
Causing prolonged impairment of bodily functions
Developing a chronic illness
Examples of urgent conditions include:
Abdominal pain of unknown cause
Unremitting new symptoms of dizziness
Medical care given for a condition that:
Is not emergent or urgent in nature
A delay of several hours would NOT increase the likelihood of an adverse outcome
Examples of non-urgent sick visit include:
Medical care given to diagnose and treat conditions to prevent deterioration:
Minimize/reduce risk of development of chronic illness
Minimize the need for complex treatments
Help prevent health problems before symptoms appear
Examples of routine primary care visits include:
Breast, cervical and colorectal cancer screenings
Blood pressure, diabetes and cholesterol tests