Emergencies are occurrences that require immediate and complex medical attention (this benefit does not include ambulance services).

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Cost
$125 copay (in- or out-of-network; waived if admitted to the hospital)
Prior Authorization Required
No, unless admitted to an out-of-network hospital
Provider Referral or Order Required
No

How To Receive

Details on how to apply

  1. Report to a hospital or free-standing emergency department for evaluation, treatment, and/or stabilization.

  2. The emergency care team will determine if discharge with follow-up, observational stay, or hospital admission is appropriate.

  3. Contact the AZ Blue BlueJourney Team at 1-800-446-8331 (TTY 711) for prior authorization if an inpatient admission at an out-of-network hospital is required.

    • It is likely that the admitting provider or hospital will help with authorization.

Cost sharing for necessary emergency services furnished out-of-network is the same as for such services furnished in-network.  There is additional coverage per year for emergency care and urgently needed services when traveling outside of the United States and its territories (see Worldwide Coverage for more information).

*Note that if emergency care is received at an out-of-network hospital and inpatient admission is needed after the emergency condition is stabilized, the inpatient care portion at the out-of-network hospital must be authorized by the health plan and the cost is the same as the cost-sharing at a network hospital.

Availability
Ongoing

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A medical emergency is when you, your loved one, or any other prudent layperson with an average knowledge of health and medicine, believes that medical symptoms require immediate medical attention to prevent devastating illness, loss of life, loss of a limb, or loss of function of a limb.

The medical symptoms may be significant illness, injury, severe pain (including any unexplained or uncontrolled chest pain), or a medical condition that is rapidly getting worse.

Emergency care is services that are needed to evaluate, treat, and/or stabilize an emergency medical condition and are rendered by a provider qualified to furnish emergency services.

This benefit does not include ambulance services (see Ambulance Services benefit).

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