How to get care in an emergency

An emergency is when you must be seen immediately.

Call 911 for an ambulance or go directly to the nearest emergency room (ER).

  • If you need care but you are not sure if it is an emergency, call your PCP first. He or she will help you decide if you should go to the ER, the office, or an urgent care center.
  • Call your PCP the day after your ER or urgent care center visit to make a follow-up appointment. Your PCP needs to know when you receive medical care from another health care provider.
  • Do not go back to the ER or urgent care center for follow-up care unless your PCP tells you to. It may not be covered, and you may get a bill.

You do not need approval from Keystone First to get care in an emergency. The hospital cannot turn you away. It is the law. You have the right to get the care you need. You have the right to say no to treatment. You also have the right to ask for or say no to a transfer to another hospital.

What Is an emergency?

An emergency is “a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:

  • Placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child), in serious jeopardy
  • Serious impairment to bodily functions
  • Serious dysfunction of any bodily organ or part

Emergency care away from home

There are times when you need care when you are away from home. If you are sick or need urgent or emergency care while you are away from home in the United States, here’s what you should do:

  • If you think you have an emergency, call 911 or go to the nearest ER.
  • If you are sick or need urgent care, call your PCP. Your PCP will help you decide if you need to go to the nearest ER.

Are you sure it is an emergency?

Right now, too many people go to the emergency room instead of their doctor’s office.  Your doctor knows you best and knows your medical history. The doctor knows which tests and medicine make the most sense for you. This is a good thing for your health.

Work with your PCP to find the best time to call the office and how to reach the doctor when the office is closed. Your PCP’s office is the best place to ask health-related questions. You may not get your answer until later in the day or the next day, but that is better than spending a day waiting in the emergency room. Keystone First also works with urgent care centers in your area. See our urgent care center list to find a location near you.

If your PCP is not available, you can call our Nurse Call Line 24 hours a day, 7 days a week, at 1-866-431-1514. They can answer your health-related questions or concerns. But remember, the Nurse Call Line does not take the place of your doctor.