GULF SOUTH HEALTH PLANS WAS RECOGNIZED BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE FOR ITS OUTSTANDING PREVENTIVE HEALTH SERVICES
WHEN SHOULD I GO TO THE EMERGENCY ROOM?
When should I go to the ER?
Using good judgement in deciding when to use emergency medical services is very important. Learn the signs of serious illnesses and trust your instincts. If you are alarmed by unusually severe symptoms, it is best to seek immediate care.
Call your Primary Care Physician (PCP) and describe your symptoms. Your PCP can tell you whether emergency treatment is necessary. For urgent problems that dont require emergency care, most doctors can accommodate same day appointments.
Gulf Souths Primary Care Physicians must have coverage available 24 hours a day for emergencies so its important to attempt to contact your doctor or the on-call physician even if its after office hours or on a weekend. Many doctors now keep their offices open after hours or on weekends for urgent problems.
In certain service areas and for certain beneficiary groups, Gulf South has contracted with free-standing urgent care centers. For acute minor illnesses, urgent care centers present a much faster and more economical solution than seeking care in a hospital Emergency Department.
If you are out of the Service Area, the usual, customary, and reasonable charges for emergency services will be covered. If the emergency results in an inpatient admission, you or your representative are responsible for notifying your Primary Care Physician within 48 hours of the admission for Network benefits to be considered, and to ensure certification of the admission. In any event, you must notify your Primary Care Physician or Gulf South within 48 hours. If you do not do so, Non-Network benefits and the certification penalty will apply.
The term emergency medical condition means 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--
General Guidelines for Seeking Emergency Care:
Good Reasons to Seek Care in an Emergency Department:
Illnesses or injuries for which care in an Emergency Department is not normally required:
Does Gulf South Require an Authorization from My PCP in order to cover Emergency Department Care?